Caracterización del fenotipo de cintura hipertrigliceridémica en pacientes con diabetes mellitus tipo2 en España: un estudio epidemiológico / Characterization of the hypertriglyceridemic waist phenotype in patients with type2 diabetes mellitus in Spain: An epidemiological study

Antecedentes y objetivos En los pacientes con diabetes mellitus tipo2 (DM2) la presencia de aumento de la circunferencia de la cintura y de los triglicéridos es un reflejo del aumento de la grasa visceral y de la resistencia a la insulina. Sin embargo, es escasa la información acerca de la prevalencia y de las características clínicas del fenotipo de cintura hipertrigliceridémica (CHTG) en pacientes con DM2. El objetivo del presente estudio fue analizar la prevalencia y las características de los pacientes de DM2 con CHTG. Métodos En este estudio epidemiológico transversal, llevado a cabo en centros de atención primaria de toda España entre los años 2011 y 2012, analizamos a 4.214 pacientes con DM2. El fenotipo CHTG fue definido como un aumento de la circunferencia de la cintura conforme a los criterios de la Federación Internacional de Diabetes para caucásicos (≥94cm para hombres y ≥80cm para mujeres) acompañado de niveles de triglicéridos ≥150mg/dl. Comparamos las variables demográficas, clínicas y analíticas según la presencia o ausencia del fenotipo CHTG. Resultados El 35% de los pacientes presentaron el fenotipo CHTG. Los pacientes con fenotipo CHTG tenían mayor índice de masa corporal (31,14±4,88 vs. 29,2±4,82kg/m2; p<0,001) y hemoglobina glucosilada más alta (7,38±1,2% vs. 7±1,07%; p<0,001). La presencia de hipertensión, enfermedad arterial periférica, insuficiencia cardíaca y complicaciones microvasculares fueron más frecuentes en los pacientes con fenotipo CHTG que los que no lo tenían. Los pacientes con fenotipo CHTG tenían una menor adherencia a la dieta prescrita (69,8 vs. 81%; p<0,001), al ejercicio (44,6 vs. 58,2%; p<0,001), y el aumento de peso en el año previo al estudio fue mayor (29,4 vs. 22,5%; p<0,001). Conclusiones El fenotipo CHTG es prevalente en la población DM2 española e identifica a un subgrupo de pacientes con un elevado riesgo cardiometabólico y mayor prevalencia de complicaciones diabéticas (AU)

Background and objectives In patients with type2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW. Methods We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥94cm for men and ≥80cm for women) with the presence of triglyceride levels ≥150mg/dl. We compared demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype. Results Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14±4.88 vs. 29.2±4.82kg/m2; P<.001) and glycated hemoglobin levels (7.38±1.2% vs. 7±1.07%; P<.001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; P<.001), exercise (44.6 vs. 58.2%; P<.001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; P<.001). Conclusions The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications (AU)

Characterization of the hypertriglyceridemic waist phenotype in patients with type 2 diabetes mellitus in Spain: an epidemiological study.

BACKGROUND AND OBJECTIVES: In patients with type 2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW. METHODS: We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥ 94 cm for men and ≥ 80 cm for women) with the presence of triglyceride levels ≥ 150 mg/dL. We compared the demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype. RESULTS: Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14 ±â€¯4.88 vs. 29.2 ±â€¯4.82 kg/m2; p < .001) and glycated hemoglobin levels (7.38 ±â€¯1.2% vs. 7 ±â€¯1.07%; p < .001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; p < .001), exercise (44.6 vs. 58.2%; p < .001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; p < .001). CONCLUSIONS: The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.

Olive mill wastewater-evaporation ponds long term stored: Integrated assessment of in situ bioremediation strategies based on composting and vermicomposting.

During the last two decades, the method most widely used to manage olive mill wastewater (OMW) derived from olive oil production has been its disposal in evaporation ponds. Long-term storage of OMW leads to the accumulation of toxic sediments (OMWS) rich in recalcitrant compounds with phytotoxic and antimicrobial properties, which limit their use for agronomic purpose. The aim of this study was to compare the effect of two in situ bioremediation strategies (composting and a combination of composting followed by vermicomposting) to remove the potential toxicity of the sediments derived from long-term stored OMW. The results obtained showed that the composting method assisted with the earthworms enhanced the depletion of phenolic compounds and OMWS ecotoxicity more than composting, especially during the maturation stage. Moreover, vermicomposting was more effective in the reduction of the OMWS salinity. However, a pre-composting process to the OMWS is necessary prior to vermicomposting to provide the suitable conditions for earthworms survival and activity. Furthermore, the final compost showed a phytostimulating effect. Therefore, these in situ bioremediation strategies can be considered potential tools for decontamination and recovery of long-term stored OMWS in evaporation ponds, which currently poses an unsolved environmental problem.

Characterization of the hypertriglyceridemic waist phenotype in patients with type2 diabetes mellitus in Spain: An epidemiological study. / Caracterización del fenotipo de cintura hipertrigliceridémica en pacientes con diabetes mellitus tipo2 en España: un estudio epidemiológico.

BACKGROUND AND OBJECTIVES: In patients with type2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW. METHODS: We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥94cm for men and ≥80cm for women) with the presence of triglyceride levels ≥150mg/dl. We compared demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype. RESULTS: Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14±4.88 vs. 29.2±4.82kg/m2; P<.001) and glycated hemoglobin levels (7.38±1.2% vs. 7±1.07%; P<.001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; P<.001), exercise (44.6 vs. 58.2%; P<.001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; P<.001). CONCLUSIONS: The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.

Therapeutic drug monitoring of tumour necrosis factor inhibitors in the management of chronic inflammatory diseases.

Tumour necrosis factor inhibitor therapy has drastically changed the management of chronic inflammatory diseases. Some important drawbacks that can cause loss of response during treatment with these drugs are related to their large individual variability, the disease burden and the formation of antidrug antibodies that increase its clearance. Therapeutic drug monitoring of these drugs is not yet recommended by all scientific societies, and if so, only in patients with inflammatory symptoms. Proactive therapeutic drug monitoring represents a new strategy with many potential clinical benefits, including the prevention of immunogenicity, a reduction in the need for rescue therapy and greater durability of tumour necrosis factor inhibitor treatment. The review is based on a systematic search of the literature for controlled trials, systematic reviews, experimental studies, guideline papers and cohort studies addressing the best practice in tumour necrosis factor inhibitor therapeutic drug monitoring. Although there is ample evidence supporting the use of therapeutic drug monitoring in clinical practice to achieve better outcomes, some challenges have been detected. Many studies are focused on finding solutions for the lack of standardization of analytical methods to measure tumour necrosis factor inhibitor and antidrug antibodies concentrations. Other challenges are development of effective cost-saving proactive algorithms to identify optimal drug concentrations and the research on the role of antidrug antibodies, especially in the management and prevention of loss of response. Therapeutic drug monitoring of tumour necrosis factor inhibitor offers a rational approach to the optimization of the treatment of chronic inflammatory disease. Although prospective controlled trials yield little conclusive evidence of its benefits, there is growing acceptance of its value in clinical practice.

Prótesis de recubrimiento en húmero proximal: ¿Cuál es la indicación hoy en día? / Proximal humeral resurfacing. What's today indication?

Resumen: Introducción: Los resultados funcionales de las prótesis de superficie en el húmero proximal son aceptables, pero con grandes diferencias en la tasa y causa de revisión según las diferentes series. El objetivo de nuestro trabajo fue analizar los resultados clínicos obtenidos en nuestro centro y tratar de definir al paciente ideal para este implante. Material y métodos: Estudio retrospectivo de 19 casos. Seguimiento de 31 (12-61) meses. La cirugía se indicó en casos de artrosis primaria o secundaria. Se analizaron datos demográficos, escala de Constant normalizada, cuestionario DASH, complicaciones y satisfacción. Hubo tres pérdidas durante el seguimiento por fallecimiento sin relación con la cirugía. Resultados: Edad media de 56 (25-80) años. La puntuación en la escala de Constant normalizada fue 73 (23-104) puntos y en el cuestionario DASH 31 (7-84) puntos. Noventa y cuatro por ciento de los pacientes retomaron sus actividades de ocio. En siete casos se objetivó radiológicamente colocación en varo del implante generando un conflicto inferior en la glena. Se produjo una capsulitis adhesiva resuelta de forma conservadora, tres reintervenciones por usura glenoidea sintomática y una por dolor incontrolable. Los pacientes sin lesión del manguito rotador presentaron mejor puntuación en los cuestionarios funcionales. Todos los pacientes refirieron estar satisfechos con la mejoría sintomática respecto a la situación previa. Conclusiones: Los resultados funcionales obtenidos son similares a los publicados previamente. Creemos que la prótesis de superficie debe ser considerada una opción en los casos de artrosis primaria o secundaria sin lesión del manguito rotador, independientemente de la edad.

Abstract: Introduction: Data published in the literature about humeral resurfacing prostheses are not conclusive with good functional results but with large differences in the revision rate. The aim of our study was to evaluate the clinical and functional outcomes in patients operated at our center. Material and methods: Retrospective study of 19 cases in 18 patients. Follow-up of 31 (12-61) months. Surgery was indicated in cases of primary or secondary osteoarthritis. Demographic data, Constant scale, DASH questionnaire, complications and satisfaction were analyzed. Three patients were lost to follow-up due to death unrelated to surgery. Results: Mean age of 56 (25-80) years. Constant normalized of 73 (23-104) points. DASH questionnaire of 31 (7-84) points. Ninety four percent of the patients resumed their recreational activities and 81% sports activities. In seven cases, inferior conflict in the glenoid with varus implant was observed radiologically. There were five complications; a conservatively resolved capsulitis, three reinterventions due to symptomatic inferior glenoid usury and another to uncontrollable pain in a conservative way. Patients without rotator cuff lesion presented better scores on the functional questionnaires. All patients were satisfied with the symptomatic improvement over the previous situation and would be operated again if necessary. Conclusions: The functional outcomes reported are similar to those previously published and, based on them, we believe that the resurfacing prosthesis is an option to be considered in cases of primary or secondary osteoarthritis when there is no rotator cuff injury, regardless of age.

[Proximal humeral resurfacing. Whats today indication?] / Prótesis de recubrimiento en húmero proximal: ¿Cuál es la indicación hoy en día?

INTRODUCTION: Data published in the literature about humeral resurfacing prostheses are not conclusive with good functional results but with large differences in the revision rate. The aim of our study was to evaluate the clinical and functional outcomes in patients operated at our center. MATERIAL AND METHODS: Retrospective study of 19 cases in 18 patients. Follow-up of 31 (12-61) months. Surgery was indicated in cases of primary or secondary osteoarthritis. Demographic data, Constant scale, DASH questionnaire, complications and satisfaction were analyzed. Three patients were lost to follow-up due to death unrelated to surgery. RESULTS: Mean age of 56 (25-80) years. Constant normalized of 73 (23-104) points. DASH questionnaire of 31 (7-84) points. Ninety four percent of the patients resumed their recreational activities and 81% sports activities. In seven cases, inferior conflict in the glenoid with varus implant was observed radiologically. There were five complications; a conservatively resolved capsulitis, three reinterventions due to symptomatic inferior glenoid usury and another to uncontrollable pain in a conservative way. Patients without rotator cuff lesion presented better scores on the functional questionnaires. All patients were satisfied with the symptomatic improvement over the previous situation and would be operated again if necessary. CONCLUSIONS: The functional outcomes reported are similar to those previously published and, based on them, we believe that the resurfacing prosthesis is an option to be considered in cases of primary or secondary osteoarthritis when there is no rotator cuff injury, regardless of age.

INTRODUCCIÓN: Los resultados funcionales de las prótesis de superficie en el húmero proximal son aceptables, pero con grandes diferencias en la tasa y causa de revisión según las diferentes series. El objetivo de nuestro trabajo fue analizar los resultados clínicos obtenidos en nuestro centro y tratar de definir al paciente ideal para este implante. MATERIAL Y MÉTODOS: Estudio retrospectivo de 19 casos. Seguimiento de 31 (12-61) meses. La cirugía se indicó en casos de artrosis primaria o secundaria. Se analizaron datos demográficos, escala de Constant normalizada, cuestionario DASH, complicaciones y satisfacción. Hubo tres pérdidas durante el seguimiento por fallecimiento sin relación con la cirugía. RESULTADOS: Edad media de 56 (25-80) años. La puntuación en la escala de Constant normalizada fue 73 (23-104) puntos y en el cuestionario DASH 31 (7-84) puntos. Noventa y cuatro por ciento de los pacientes retomaron sus actividades de ocio. En siete casos se objetivó radiológicamente colocación en varo del implante generando un conflicto inferior en la glena. Se produjo una capsulitis adhesiva resuelta de forma conservadora, tres reintervenciones por usura glenoidea sintomática y una por dolor incontrolable. Los pacientes sin lesión del manguito rotador presentaron mejor puntuación en los cuestionarios funcionales. Todos los pacientes refirieron estar satisfechos con la mejoría sintomática respecto a la situación previa. CONCLUSIONES: Los resultados funcionales obtenidos son similares a los publicados previamente. Creemos que la prótesis de superficie debe ser considerada una opción en los casos de artrosis primaria o secundaria sin lesión del manguito rotador, independientemente de la edad.

Pharmacokinetics and dosing requirements of digoxin in pregnant women treated for fetal supraventricular tachycardia.

BACKGROUND: The objective of this study was to characterize the pharmacokinetics (PK) of digoxin in pregnant women and its potential implications for drug dosing. METHODS: Serum digoxin concentrations (SDCs) obtained in pregnant women treated for fetal supraventricular tachycardia (SVT) was retrospectively collected. PK analysis was comparatively performed using a two-stage approach (PKS™) and a Population PK approach (NONMEM™). As clinical outcome the fetal heart rate was recorded. RESULTS: A total of 42 SDCs were obtained from 8 women in the 3rd trimester of pregnancy (mean age 33.0 years). The PK parameters estimated by both two-stage (volume of distribution (Vd) = 682.0 L, CV = 47.5%; serum clearance (CL) = 16.1 L/h, CV = 19%) and population approaches (Vd = 731.3 L, CV = 30.5%; CL = 18.7 L/h, CV = 17.8%) are very similar and show a clear trend of increasing drug disposition in the third trimester of pregnancy. An oral loading dose of 0.5 mg/8 h during 24 h followed by a maintenance regimen of 0.5 mg/12 h been recommended to start treatment. CONCLUSIONS: Despite the small population, these parameters could be used as a guide to calculate the initial dosage requirements in the third trimester of pregnancy for treating fetal SVT. In addition, maternal SDCs should be routinely monitored for dosage adjustment purposes.

Quantitative analysis of blood cells and inflammatory factors in wounds.

OBJECTIVE: The aim of this study was to quantify blood cells and inflammatory markers, involved in the healing process, in exudates from wounds in different healing phases, to assess these markers in order to identify the inflammatory phase of the wounds. METHOD: Patients who presented with postsurgical wounds, which closed by first and second intention, and those who presented with pressure ulcers (PUs), which were closed by second intention, were included in the study. RESULTS: We examined wounds from 37 patients and collected samples from 52 wounds in the inflammatory phase, 30 in the proliferative phase and 29 in the maturation phase. The number of neutrophils and platelets in the exudate collected from wounds in the inflammatory phase was significantly higher (p<0.001), while the number of lymphocytes, was significantly lower in exudate from wounds in the inflammatory phase (p<0.001). Wound c-reactive protein (CRP) and immunoglobulin G (IgG) levels were higher in the inflammatory group (p<0.001). We found a significantly positive correlation between CRP levels and the percentage of neutrophils and monocytes (r=0.346, p=0.004; r=0.293, p=0.015), and a significantly negative correlation between CRP levels and the percentage of lymphocytes (r=-0.503, p<0.001). A stepwise logistic regression analysis was used to identify an optimal combination of these biomarkers. The optimal biomarker combinations were neutrophils + monocytes + platelets + IgG + CRP, with an area under the curve (AUC) of 0.981 [confidence interval (CI) 95%: 0.955-1.000, p<0.001] for the diagnosis of wounds in the inflammatory phase. The optimal cutpoint yielded 96.9 % sensitivity and 94.6 % specificity. The biomarker combination predicted the inflammatory phase and was superior to individual biomarkers. CONCLUSION: Our findings suggest that the combination of the markers, percentage of neutrophils and monocytes, platelets, CRP and IgG levels could be useful prognostic indicators of the inflammatory phase.

Effect of diet on carboxylesterase activity of tadpoles (Rhinella arenarum) exposed to chlorpyrifos.

An outdoor microcosm was performed with tadpoles (Rhinella arenarum) exposed to 125µgL-1 chlorpyrifos and fed two types of food, i.e., lettuce (Lactuca sativa) and a formulated commercial pellet. Acetylcholinesterase (AChE) and carboxylesterase (CbE) activities were measured in liver and intestine after 10 days of pesticide exposure. Non-exposed tadpoles fed lettuce had an intestinal AChE activity almost two-fold higher than that of pellet-fed tadpoles. No significant differences were observed, however, in liver AChE activity between diets. Likewise, intestinal CbE activity - measured using two substrates, i.e. 1-naphthyl acetate (1-NA) and 4-nitrophenyl valerate (4-NPV) - was higher in tadpoles fed lettuce than in those fed pellets. However, the diet-dependent response of liver CbE activity was opposite to that in the intestine. Chlorpyrifos caused a significant inhibition of both esterase activities, which was tissue- and diet-specific. The highest inhibition degree was found in the intestinal AChE and CbE activities of lettuce-fed tadpoles (42-78% of controls) compared with pellet-fed tadpoles (<60%). Although chlorpyrifos significantly inhibited liver CbE activity of the group fed lettuce, this effect was not observed in the group fed pellets. In general, intestinal CbE activity was more sensitive to chlorpyrifos inhibition than AChE activity. This finding, together with the high levels of basal CbE activity found in the intestine, may be understood as a detoxification system able to reduce intestinal OP uptake. Moreover, the results of this study suggest that diet is a determinant factor in toxicity testing with tadpoles to assess OP toxicity, because it modulates levels of this potential detoxifying enzyme activity.

From autochthonous to allochthonous resources: seasonal shifts in food use by stream-dwelling YOY Arctic charr Salvelinus alpinus through the ice-free season.

Substantial seasonal changes in resource use associated with enhanced water-column use were revealed in stream-living YOY Arctic charr Salvelinus alpinus during the ice-free season. In July, YOY individuals showed a diet dominated by aquatic invertebrates (mainly Chironomidae larvae), but despite the small size of the fish, the abundance of terrestrial insects in their diet increased markedly from July to September (from 1·9 to 62·8%). Similarly, the frequency of surface drifting foragers, i.e. individuals feeding on allochthonous resources, increased from July to September (from 20·6 to 80%); allochthonous resources thus constituting an important energy subsidy for YOY S. alpinus during the late sub-Arctic summer.

Hepatic biotransformation and antioxidant enzyme activities in Mediterranean fish from different habitat depths.

Marine fish are threatened by anthropogenic chemical discharges. However, knowledge on adverse effects on deep-sea fish or their detoxification capabilities is limited. Herein, we compared the basal activities of selected hepatic detoxification enzymes in several species (Solea solea, Dicentrarchus labrax, Trachyrhynchus scabrus, Mora moro, Cataetix laticeps and Alepocehalus rostratus) collected from the coast, middle and lower slopes of the Blanes Canyon region (Catalan continental margin, NW Mediterranean Sea). The xenobiotic-detoxifying enzymes analysed were the phase-I carboxylesterases (CbEs), and the phase-II conjugation activities uridine diphosphate glucuronyltransferase (UDPGT) and glutathione S-transferase (GST). Moreover, some antioxidant enzyme activities, i.e., catalase (CAT), glutathione peroxidase (GPX) and glutathione reductase (GR), were also included in this comparative study. Because CbE activity is represented by multiple isoforms, the substrates α-naphthyl acetate (αNA) and ρ-nitrophenyl acetate (ρNPA) were used in the enzyme assays, and in vitro inhibition kinetics with dichlorvos were performed to compare interspecific CbE sensitivity. Activity of xenobiotic detoxification enzymes varied among the species, following a trend with habitat depth and body size. Thus, UDPGT and some antioxidant enzyme activities decreased in fish inhabiting lower slopes of deep-sea, whereas UDPGT and αNA-CbE activities were negatively related to fish size. A trend between CbE activities and the IC50 values for dichlorvos suggested S. solea and M. moro as potentially more sensitive to anticholinesterasic pesticides, and T. scabrus as the most resistant one. A principal component analysis considering all enzyme activities clearly identified the species but this grouping was not related to habitat depth or phylogeny. Although these results can be taken as baseline levels of the main xenobiotic detoxification enzymes in Mediterranean fish, further research is needed to evaluate their response to environmental contaminant exposure.

A comparative MRI study for white matter hyperintensities detection: 2D-FLAIR, FSE PD 2D, 3D-FLAIR and FLAIR MIP.

OBJECTIVE: The main objective of this study was to not only determine the most appropriate sequence for the analysis of white matter hyperintensities (WMH) on MRI but also to confirm the advantage of three-dimensional (3D) acquisition, as it has been suggested in previous studies, and to test the convenience of using maximum intensity projection (MIP) algorithms on 3D-fluid-attenuated inversion-recovery (FLAIR) images for a quicker evaluation of brain MR studies. METHODS: The number of WMH was compared in 40 patients and a control group of 10 volunteers using 4 different imaging modalities: two dimensional (2D)-FLAIR, 2D fast spin echo proton density (FSE PD), 3D-FLAIR and FLAIR MIP. Four experienced radiologists took part in the imaging analysis. All studies were performed on a 1.5-T whole-body MR unit. RESULTS: A statistically significant difference between the number of lesions detected on 3D acquisitions (FLAIR CUBE® or FLAIR MIP sequences) compared with those on 2D-FLAIR or 2D FSE PD was demonstrated. There is no significant difference between 3D-FLAIR and FLAIR MIP, therefore both of them can be used with similar results. CONCLUSION: 3D-FLAIR sequences should replace conventional 2D-FLAIR and/or FSE PD sequences in the MR acquisition protocol when WMH are suspected. MIP reformat algorithms are less time consuming, therefore these can also be used to simplify the detection. ADVANCES IN KNOWLEDGE: 3D sequences are superior for WMH depiction. Moreover, MIP algorithms allow easier analyses with similar results.

Hamartomatosis biliar en una lactante con colitis alérgica. Revisión a propósito de un caso / Biliary hamarthomatosis in an infant with alergic colitis. A case report

La hamartomatosis biliar múltiple (HBM) aparece en el 0,9% de los niños. Su origen está en una disembriogénesis. Los hamartomas de la HBM tienen un color blanco-grisáceo, y pueden estar localizados en la región subcapsular o dispersos por el parénquima. Su tamaño suele ser inferior a 3 mm. Clínicamente, la HBM sigue un curso asintomático. El diagnóstico de la HBM requiere inicialmente una prueba de imagen (ecografía, tomografía computarizada o resonancia magnética). Desde el punto de vista histológico, cada hamartoma consta de varios grupos de conductos biliares intrahepáticos dilatados en un estroma fibrilar de colágeno denso que puede hialinizarse y/o calcificarse. La HBM no precisa tratamiento, dado su bajo potencial de malignización (AU)

Biliary hamartomatosis (BH) occurs in 0.9% of children. Its origin is dysembriogenesis. Hamartomas of this disease show grey-white color, and can be located in subcapsular region or scattered at the parenchyma. Its size is usually less than 3 mm. Clinically, BH follows an asymptomatic course. The diagnosis of HBM initially requires an imaging test (ultrasound, CT or MRI). Histologically, each hamartoma has several groups of dilated intrahepatic bile ducts in a stroma that may be hyalinazed and/or calcified. BH do not require treatment, because its malignant potential is slow (AU)

Parámetros de marcha en una muestra de referencia de escolares sanos españoles: descripción multivariante y asimetrías entre ciclos izquierdos y derechos / Gait parameters in a reference sample of healthy Spanish schoolchildren: multivariate descriptive statistics and asymmetries observed in left and right cycles

Introducción: El análisis instrumental de marcha (AIM) es una tecnología de uso creciente en la evaluación de trastornos motores infantiles. La evaluación de pacientes requiere una base de referencia de normalidad, pero existen pocas referencias infantiles españolas. Objetivo: Descripción de 16 variables de marcha de relevancia clínica en una muestra de referencia de escolares sanos. Estudio de sus relaciones lineales y asimetrías izquierda-derecha. Sujetos y métodos: Se midieron con AIM 16 variables de marcha en escolares sanos (n = 27, 5-13 años). Se estudiaron las asimetrías en cada variable (t de Student, muestras dependientes) y sus intervalos de confianza (95% de la media de diferencia estandarizada derecha menos izquierda, dz). Se representaron los valores y las asociaciones entre variables mediante «heatmap». Resultados: Se aportan tablas de normalidad para 16 variables del ciclo de marcha. Son significativamente asimétricos los valores medios de flexión mínima de cadera (dz: 0,25 IC del 95%, 0,11-0,39) y de máxima abducción de cadera en el balanceo (dz: -1,05 IC del 95%, —1,71; —0,27). Existen asociaciones funcionales entre las variables de marcha. Conclusiones: Presentamos una muestra de normalidad de escolares españoles donde se observan asimetrías entre los lados izquierdo y derecho y organización funcional entre sus variables (AU)

Introduction: Instrumental gait analysis is an emerging technology used increasingly to evaluate motor disorders in children. Normal reference data is necessary in order to evaluate patients, but there are few reference resources for the Spanish paediatric population. Objective: We aim to describe the values of 16 clinically relevant gait variables in healthy Spanish schoolchildren, and identify any linear associations or left-right asymmetries. Subjects and methods: The values of 16 gait variables were determined in schoolchildren (n = 27, aged 5-13 years) using instrumental gait analysis. We analysed asymmetries for each variable (Student’s t-test for dependent samples) and calculated their confidence intervals (95% of the standardised difference in right and left means [SMD]). Values and associations between variables were represented using a heat map. Results: Our project presents normal values tables for 16 variables in the gait cycle. Significant asymmetries were detected in the mean values for minimum hip flexion (SMD: 0.25 95% CI, 0.11-0.39) and peak hip abduction in swing (SMD: −1.05 95% CI: −1.71- − 0.27). Functional associations among gait variables are present. Conclusions: We present a reference dataset for Spanish school-aged children in which leftright asymmetries and functional associations may be observed for different variables (AU)

Degeneración hipertrófica de la oliva por lesión del triángulo de Guillain-Mollaret. Presentación de 2 casos / Hypertrophic olivary degeneration secondary to a Guillain-Mollaret triangle lesion

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Gait parameters in a reference sample of healthy Spanish schoolchildren: multivariate descriptive statistics and asymmetries observed in left and right cycles.

INTRODUCTION: Instrumental gait analysis is an emerging technology used increasingly to evaluate motor disorders in children. Normal reference data is necessary in order to evaluate patients, but there are few reference resources for the Spanish paediatric population. OBJECTIVE: We aim to describe the values of 16 clinically relevant gait variables in healthy Spanish schoolchildren, and identify any linear associations or left-right asymmetries. SUBJECTS AND METHODS: The values of 16 gait variables were determined in schoolchildren (n=27, aged 5-13 years) using instrumental gait analysis. We analysed asymmetries for each variable (Student's t-test for dependent samples) and calculated their confidence intervals (95% of the standardised difference in right and left means [SMD]). Values and associations between variables were represented using a heat map. RESULTS: Our project presents normal values tables for 16 variables in the gait cycle. Significant asymmetries were detected in the mean values for minimum hip flexion (SMD: 0.25 95% CI, 0.11-0.39) and peak hip abduction in swing (SMD: -1.05 95% CI: -1.71--0.27). Functional associations among gait variables are present. CONCLUSIONS: We present a reference dataset for Spanish school-aged children in which left-right asymmetries and functional associations may be observed for different variables.

[Concordance analysis of referrals from Primary Care to Mental Health]. / Análisis de concordancia de las derivaciones de atención primaria a salud mental.

APPROACH: Proper coordination between Primary Care (PC) and Mental Health Units (MHU) is needed, and referrals between the two systems are an important issue. We attempt to analyse various aspects on the variation between referrals from PC to MHU in the Burgos area. METHODOLOGY: Descriptive cross-sectional study, including all first-time referral patients from PC to MHU in Burgos in 2006: 1132 referrals. RESULTS: Waiting time for the first consultation with the specialist was less than 30 days in 38% of cases, and between 30 and 45 days in 36.1% of the case. The agreement between Family Doctors (FD) requests (psychiatry/clinical psychology) and the specialist performing first consultation was very high (Kappa Index 0.784). The most common diagnosis in PC were anxiety disorders (29%) and depression disorders (25%). The most common diagnosis in MHU were adaptation disorders (26%), anxiety disorders (21%), and depression disorders (19%). Diagnostic agreement between Primary care and Specialist care was low (Kappa Index 0.342). Specialists judged referrals appropriate or very appropriate in 72.4% of the cases, and deemed the information in the referral form to be adequate in 56.7% of the cases. As regards the referral type (ordinary, preferential or urgent), the agreement between PC and Mental Health specialists was very low (Kappa Index 0.179). In 75.9% of referrals, psychiatrist and clinical psychologist indicated not having had previous contact with the primary care physician. Almost half (47.7%) of referred patients indicated previous pharmacological treatment in PC. CONCLUSIONS: The degree of agreement between PC and MHU was very high in terms of specialist requested and attending specialist (psychiatry/clinical psychologist), was low in terms of diagnostic agreement, and it was very low in terms of referral type. This suggests a need to reinforce the relationship between both care systems.

Análisis de concordancia de las derivaciones de atención primaria a salud mental / Concordance analysis of referrals from Primary Care to Mental Health

Planteamiento. Es necesaria una correcta coordinación entre atención primaria (AP) y los equipos de salud mental (ESM), siendo el punto crítico la derivación entre ambos sistemas. Nos propusimos analizar la concordancia de las derivaciones realizadas desde AP a los ESM de Burgos. Metodología. Estudio descriptivo transversal, con inclusión de los pacientes nuevos derivados desde AP a ESM de Burgos durante 2006: 1.132 derivaciones. Resultados. El tiempo de demora para la primera consulta fue inferior a 30 días en el 38% de los casos, de 30-45 días en 36,1%. El índice de concordancia entre la demanda del médico de AP y el facultativo de salud mental que atendió en primera consulta fue muy alta (índice kappa 0,784). Los diagnósticos más indicados por AP fueron trastornos de ansiedad (29%) y trastornos afectivos (25%). Los diagnósticos más frecuentes en los ESM fueron los trastornos adaptativos (26%), de ansiedad (21%) y afectivos (19%). La concordancia diagnóstica entre AP y ESM fue baja (índice kappa 0,342). Los ESM consideraron adecuadas o muy adecuadas las derivaciones en el 72,4% de los casos, y correcta la información de derivación en el 56,7%. En cuanto al carácter de la derivación (ordinaria, preferente o urgente), el acuerdo entre la calificación otorgada por AP y por ESM fue muy bajo (índice kappa 0,179). En el 75,9% de las ocasiones, psiquiatras y psicólogos clínicos indicaron no haber mantenido ningún contacto previo con AP. El 47,7% de los pacientes acudían al ESM con tratamiento farmacológico pautado en AP. Conclusiones. El grado de acuerdo entre AP y ESM fue muy alto en cuanto al profesional demandado y el que finalmente atendió (psiquiatra/psicólogo clínico), bajo en la concordancia diagnóstica, y muy bajo en lo que al carácter de la derivación se refiere, lo cual indica la necesidad de reforzar los vínculos informativos entre ambos sistemas asistenciales (AU)

Approach. Proper coordination between Primary Care (PC) and Mental Health Units (MHU) is needed, and referrals between the two systems are an important issue. We attempt to analyse various aspects on the variation between referrals from PC to MHU in the Burgos area. Methodology. Descriptive cross-sectional study, including all first-time referral patients from PC to MHU in Burgos in 2006: 1132 referrals. Results. Waiting time for the first consultation with the specialist was less than 30 days in 38% of cases, and between 30 and 45 days in 36.1% of the case. The agreement between Family Doctors (FD) requests (psychiatry/clinical psychology) and the specialist performing first consultation was very high (Kappa Index 0.784). The most common diagnosis in PC were anxiety disorders (29%) and depression disorders (25%). The most common diagnosis in MHU were adaptation disorders (26%), anxiety disorders (21%), and depression disorders (19%). Diagnostic agreement between Primary care and Specialist care was low (Kappa Index 0.342). Specialists judged referrals appropriate or very appropriate in 72.4% of the cases, and deemed the information in the referral form to be adequate in 56.7% of the cases. As regards the referral type (ordinary, preferential or urgent), the agreement between PC and Mental Health specialists was very low (Kappa Index 0.179). In 75.9% of referrals, psychiatrist and clinical psychologist indicated not having had previous contact with the primary care physician. Almost half (47.7%) of referred patients indicated previous pharmacological treatment in PC. Conclusions. The degree of agreement between PC and MHU was very high in terms of specialist requested and attending specialist (psychiatry/clinical psychologist), was low in terms of diagnostic agreement, and it was very low in terms of referral type. This suggests a need to reinforce the relationship between both care systems (AU)