Indicators to evaluate quality of care in head and neck cancer in Spain.

PURPOSE: This study aimed to develop a set of criteria and indicators to evaluate the quality of care of patients with head and neck cancer (HNC). METHODS: A systematic literature review was conducted to identify valuable criteria/indicators for the assessment of the quality of care in HNC. With the aid of a technical group, a scientific committee of oncologists specialised in HNC used selected criteria to propose indicators that were evaluated with a two-round Delphi method. Indicators on which consensus was achieved were then prioritised by the scientific committee to develop a final set of indicators. RESULTS: We proposed a list of 50 indicators used in the literature or developed by us to be evaluated with a Delphi method. There was consensus on the appropriateness of 47 indicators in the first round; the remaining 3 achieved consensus in the second round. The 50 indicators were scored to prioritise them, leading to a final selection of 29 indicators related to structure (3), process (22), or outcome (4) and covering diagnosis, treatment, follow-up, and health outcomes in patients with HNC. Easy-to-use index cards were developed for each indicator, with their criterion, definition, formula for use in real-world clinical practice, rationale, and acceptable level of attainment. CONCLUSIONS: We have developed a set of 29 evidence-based and expert-supported indicators for evaluating the quality of care in HNC, covering diagnosis, treatment, follow-up, and health outcomes.

DHA Supplementation during Pregnancy in Women with Obesity Normalizes IGF2R Levels in the Placenta of Male Newborns.

Introduction: Insulin-like growth factor receptor 2 (IGF2R) regulates placental nutrient transport, and its soluble form is related to obesity in adults. If the placental expression of IGF2R is altered in women with obesity is unknown. Whether maternal supplementation with docosahexaenoic acid (DHA), a polyunsaturated fatty acid with anti-inflammatory properties, has a modulatory role in IGF2R's function has not been elucidated. We hypothesized that maternal obesity (Ob) would be associated with alterations in placental IGF2R expression, which may be prevented with DHA supplementation during pregnancy. Methods: At delivery, we obtained placentas from women with Ob (BMI ≥ 30 kg/m2, n = 17), Ob supplemented with 800 mg/day of DHA during pregnancy (Ob + DHA, n = 13), and normal-weight women (Nw, BMI ≥ 18.5 ≤ 24.9 kg/m2, n = 14). The IGF2R mRNA and protein were determined by RT-PCR and western blotting, respectively. Moreover, we quantified the gene expression of molecules that modulate the IGF2R function in the extracellular domain, such as TACE/ADAM17, PLAU, and IGF2. Mann-Whitney and Kruskal-Wallis nonparametric tests were used to compare results between two or three groups accordingly. Results: The IGF2R levels in the Ob placentas of the male offspring were higher than in the Nw group. The DHA supplementation prevented this effect, suggesting an unknown relationship between IGF2R-Ob-DHA in placental tissues. Conclusion: We report, for the first time, that DHA supplementation during pregnancy in women with obesity normalizes the increased IGF2R levels in male placentas, reducing the risk of adverse outcomes related to the IGF2/IGF2R system in male newborns.

Alternative Ecosorbent for the Determination of Trihalomethanes in Aqueous Samples in SPME Mode.

A new sorbent material based on modified clay with ionic liquid immobilized into an agarose film was developed as part of this study. It was applied to determine organochlorine pollutants, like disinfection byproducts, through headspace solid-phase microextraction-gas chromatography-electron capture detection (HS-SPME-GC-ECD). The disinfection byproducts determined in this study were used as model molecules because they were volatile compounds, with proven severe effects on human health. Their presence in aquatic environments is in trace concentrations (from pg L-1 to mg L-1). They are classified as emergent pollutants and their determination is a challenge for analytical chemists. The parameters which affected the extraction efficiency, i.e., number and distance between SPME discs, salt concentration, the temperature of extraction, extraction time, and desorption time, were optimized. A wide linear dynamic range of 10-1000 ng mL-1 and coefficients of determination better than 0.997 were achieved. The limits of detection and the limits of quantitation were found in the ranges of (1.7-3.7) ng mL-1 and (5.6-9.9) ng mL-1, respectively. The precision, expressed as relative standard deviation (RSD), was better than 8%. The developed sorbent exhibits good adsorption affinity. The applicability of the proposed methodology for the analysis of trihalomethanes in environmental and water samples showed recoveries in the range of 86-95%. Finally, the newly created method fully complied with the principles of green chemistry. Due to the fact that the sorbent holder was made of agarose, which is a wholly biodegradable material, sorbent clay is a widespread material in nature. Moreover, the reagents intercalated into the montmorillonite are new green solvents, and during the whole procedure, low amounts of organic solvents were used.

Health self-perception is associated with life-styles and comorbidities and its effect on mortality is confounded by age. A population based study.

Background: Health self-perception (HSP) is the individual and subjective concept that a person has of their state of health. Despite its simplicity, HSP is considered a valid and relevant indicator employed in epidemiological research and in professional practice as an overall measure of health. Objectives: (1) To describe and analyze the associations between HSP and demographic variables, lifestyle and diseases prevalent in a population and (2) to investigate the relationship between HSP and mortality. Materials and methods: In a primary care setting, we conducted a longitudinal study of a random populational sample of a Galician municipality, stratified by decade of life. A total of 1,516 adults older than 18 years, recruited by the 2013-2015 AEGIS study, were followed-up for more than 5 years. During the clinical interview, data were collected on lifestyle and prevalent diseases. The HSP was grouped into 2 categories (good/poor). The statistical analysis consisted of a logistic regression, Kaplan-Meier curves and Cox regression. Results: A total of 540 (35.6%) participants reported poor HSP. At the end of the follow-up, 78 participants had died (5.1%). The participants with increased age and body mass index and chronic diseases (anxiety, depression, ischemic heart disease, diabetes, and cancer) presented a poorer subjective health. A high level of physical activity and moderate alcohol consumption were associated with better HSP. A poorer HSP was associated with increased mortality, an association that disappeared after adjusting for the rest of the covariates (HR, 0.82; 95% CI 0.50-1.33). Conclusion: (1) Health self-perception is associated with age, lifestyle, and certain prevalent diseases. (2) A poorer HSP is associated with increased mortality, but this predictive capacity disappeared after adjusting for potential confounders such as age, lifestyle, and prevalent diseases.

Death in custody in Spain: Excited delirium syndrome. Importance of a multidisciplinary approach.

This article aims to analyse the excited delirium syndrome, especially, when Law Enforcement Officers have to make use of force and deaths in custody occur. Through a bibliographic review, inferences have been obtained to identify, in first place, what a death in custody is and the differences between positional asphyxia and excited delirium syndrome. Subsequently, we have summarized the major findings that the medical examiner should look for in order to diagnose the excited delirium syndrome from the scene examination, the autopsy and the complementary analysis. Finally, we propose some directives that may help to avoid the death of these subjects and to study them in case they occur.

Rhinosporidiosis in the Americas: A Systematic Review of Native Cases.

Rhinosporidiosis is a chronic mucosal infection caused by Rhinosporidium seeberi, an aquatic protistan parasite. It presents as nasal or ocular polypoidal or vascularized masses. It is endemic in tropical and subtropical areas, especially in South Asia; R. seeberi´s endemicity in the Americas is often overlooked. The objective of this study was to describe the demographic and clinical characteristics of patients with rhinosporidiosis in the Americas, its management, and patient outcomes. This study is a systematic review of cases of human rhinosporidiosis in the Americas reported in the literature from 1896 to February 28, 2019. This review screened 1,994 reports, of which 115 were eligible for further analysis. The selected reports described 286 cases of human rhinosporidiosis between 1896 and 2019. Cases were diagnosed in Brazil (32.2%), Colombia (24.4%), Paraguay (12.6%), and the United States (11.9%). The majority of the cases (91%) occurred in geographic areas with altitudes < 1,000 m above sea level and in areas with median temperatures ≥ 25°C (67.3%). Most of the patients presented nasal (65%) and ocular involvement (35%). Surgical treatment was provided for 99.6% of patients, but 19.8% of them recurred. This review describes the under-recognized geographic distribution and clinical presentation of rhinosporidiosis in the Americas and highlights clinical differences to cases in Asia, specifically in reference to a higher prevalence of ocular disease and higher relapse rates.

Desarrollo de un método analítico de preparación de muestras de alimentos para determinar óxidos de colesterol (COP) mediante cromatografía / Development of an analytical method of food samples preparation to determine cholesterol oxides (COP) by chromatography / Desenvolvimento de um método analítico de preparação de amostras de E alimentos para determinar óxidos de colesterol (COP) por meio de cromatografia E

Resumen Las transformaciones surgidas durante los procesos de limpieza de los alimentos grasos para determinar productos de oxidación de colesterol (COP) limitan los resultados reales en un estudio. Por tanto, el objetivo de este estudio fue comparar los COP obtenidos por distintos métodos de extracción: fase sólida (SPE) y cromatografía líquida en fase normal y reversa, comparando sus perfiles de elución. Adicionalmente, se tuvo como objetivo optimizar los procesos de limpieza para reducir las transformaciones de COP. Se usaron muestras de lomo de cerdo crudo, jamón serrano y salmón ahumado. Las transformaciones de COP se determinaron por SPE y GC-FID y se optimizaron los métodos de limpieza con la técnica SPE. Los cartuchos apolares no mostraron transformación de COP durante el tratamiento de muestras y los cambios de pH generaron transformaciones del triol a 6 ceto epóxido. Debido a que la limpieza del cartucho suele ser deficiente y genera coelución de compuestos indeseables (ácidos grasos) implicados en la transformación de epóxidos α y β en triol, estas transformaciones se evitaron con la técnica SPE, uso de cartuchos C18, con ajuste del volumen de elución de MeOH y ajustes del pH. La reducción de los pasos de la limpieza de muestras optimizó el proceso en un 73%.

Abstract When determining cholesterol oxidation products (COP), transformations during cleaning processes of fatty foods limit the real results in a study. Therefore, the objective of this study was to compare the COP obtained by different extraction methods, normal and reverse phase liquid chromatography and solid phase extraction (SPE), as well as their resulting elution profile. Another goal was to optimize the cleaning processes to reduce COP transformations. Samples of raw pork loin, serrano ham and smoked salmon were used. Transformations of COP were determined by SPE and GC-FID and cleaning methods with SPE technique were optimized. The apolar cartridges did not show COP transformation during samples treatment and pH changes generated transformations of triol to 6 keto epoxide. Due to cartridge cleaning is usually deficient and generates coelution of undesirable compounds (fatty acids) involved in the transformation of α and β epoxides in triol, these transformations were avoided with the SPE technique, C18 cartridges, with adjustment of the MeOH elution volume, and pH settings. Reduction of samples cleaning steps optimized the process in 73%.

Resumo As transformações que surgem durante os E processos de limpeza de alimentos gordurosos para determinar os produtos de oxidação do ^ colesterol (COP) limitam os resultados reais de um estudo. Por tanto, o objetivo deste estudo foi comparar os COP obtidos pelos métodos de extração SPE e cromatografia líquida em fase normal e fase reversa, e seus perfiles de eluição. Além de otimizar os processos de limpeza para reduzir as transformações dos COP. Foram utilizadas amostras de lombo de porco cru, presunto serrano e salmão defumado. As transformações dos COP foram determinadas pela SPE e a GC- FID. Foram otimizados os métodos de limpeza com a técnica de SPE. Os cartuchos apolares não mostraram transformação de COP durante o tratamento das amostras; as mudanças de pH geraron transformações do triol a 6 keto epóxido. A limpeza do cartucho geralmente é deficiente e gera coeluição de compostos indesejáveis (ácidos graxos) envolvidos na transformação dos α e β epóxidos no triol. Essas transformações foram evitadas com a técnica de SPE, o uso de cartuchos C18, ajuste do volume de eluição de MeOH e ajuste do pH. A redução das etapas de limpeza das amostras otimizou o processo em 73%.

Hipercloremia y mortalidad en la unidad de cuidados intensivos / Mortality and hyperchloremia in the intensive care unit

Abstract Introduction: Administrating intravenous fluids is one of the most frequent practices in the care of critically ill patients, since most of them present shock or hypotension from any cause. The rapid and aggressive administration of these fluids may lead to adverse results, including acute renal failure and hydroelectrolytic disorders which are highly associated with fatal outcomes. Objectives: To establish the association between hyperchloremia and mortality in patients admitted to the intensive care unit (ICU) of Hospital Universitario de San José between August 2013 and January 2017, in addition to their demographic characteristics, the incidence of chloride abnormalities, and its association to renal failure. Methods: Analytic retrospective cohort study in the adult ICU at the Hospital Universitario de San José from August 1, 2013 to January 31, 2017. Results: A total of 839 patients were evaluated, 210 exposed and 629 not exposed. The relative risk of death for those who developed hyperchloremia was 3.12 (95% confidence interval [CI] 2.16^.49) (P <0.001). The multivariate analysis generated an hazard ratio of 2.31 (95% CI 1.47-3.63) adjusted for age, sex, APACHE II at admission, sepsis, neurocritical state, and development of renal failure. Conclusion: Hyperchloremia is a frequent event in patients in the ICU; it may act as an independent variable for mortality in critical patients.

Resumen Introducción: La administración de líquidos endovenosos es de los actos que con mayor frecuencia se realizan en el cuidado de los pacientes críticamente enfermos, dado que gran parte de los mismos cursan con choque o hipotensión de cualquier causa, ésta se realiza de forma agresiva y rápida, dicha administración puede conllevar a eventos desfavorables como la falla renal aguda y alteraciones hidroelectrolíticas que están altamente relacionadas con desenlaces fatales. Objetivos: Establecer la asociación entre hipercloremia y mortalidad en los pacientes hospitalizados en cuidados intensivos del hospital Universitario de San José entre agosto de 2013 y enero de 2017, así como sus características demográficas, incidencia de anormalidades del cloro y su asociación con falla renal. Métodos: Estudio analítico de cohortes retrospectiva, en la Unidad de Cuidados intensivos (UCI) adultos del Hospital Universitario de San José, en el período comprendido entre el 1 de agosto de 2013 y el 31 de enero de 2017. Resultados: Fueron evaluados 839 pacientes, 210 expuestos y 629 no expuestos. El riesgo relativo para muerte en los que desarrollaron hipercloremia fue 3.12 (IC95% 2.16-4.49) (p <0.001). En el análisis multivariado se obtuvo un HR de 2.31 (IC95% 1.473.63) ajustado por las variables de edad, sexo, APACHE II al ingreso, sepsis, estado neurocrítico y desarrollo de falla renal. Conclusiones: La hipercloremia es un evento frecuente durante la atención de los pacientes en la unidad de cuidados intensivos; puede actuar como una variable independiente de mortalidad en los pacientes críticos.

Preferential solvation of tricin in {ethanol (1) + water (2)} mixtures at several temperatures / Solvatación preferencial de tricin en mezclas etanol + agua a varias temperaturas

SUMMARY The preferential solvation parameters of tricin in {ethanol (1) + water (2)} binary mixtures were obtained from their thermodynamic properties by means of the inverse Kirkwood-Buff integrals method. Tricin is very sensitive to specific solvation effects, so the preferential solvation parameter by ethanol (1), δx 1,3 is negative in the water-rich mixtures but positive in all the other compositions at temperatures from 293.15, to 313.15 K. It is conjecturable that in water-rich mixtures the hydrophobic hydration around the aromatic and methyl groups of the drug plays a relevant role in the solvation. The higher drug solvation by ethanol in mixtures of similar solvent proportions and in ethanol-rich mixtures could be due mainly to polarity effects. In these mixtures, the drug would be acting as Lewis acid with the ethanol molecules because this co-solvent is more basic than water.

RESUMEN Los parámetros de solvatación preferencial del tricina en mezclas {etanol (1) + agua (2)} se obtuvieron a partir de las propiedades termodinámicas de solución, mediante el método de las integrales inversas de Kirkwood-Buff. La tricina es muy sensible a los efectos de solvatación específicos, por lo que el parámetro de solvatación preferencial, δx 1,3 es negativo en las mezclas ricas en agua, pero positivo en todas las otras composiciones a temperaturas desde 293,15 hasta 313,15 K. Se puede establecer que en mezclas ricas en agua la hidratación hidrofóbica alrededor de los grupos aromáticos y metilo del fármaco tiene un papel relevante en la solvatación. La mayor solvatación del fármaco por etanol se presenta en mezclas de proporción intermedia y en mezclas ricas en etanol, esto podría deberse principalmente a los efectos de la polaridad. En estas mezclas, el fármaco actuaría como ácido de Lewis con las moléculas de etanol, puesto que este codisolvente es más básico que el agua.

Klotho Gene and Protein in Human Placentas According to Birth Weight and Gestational Age.

Introduction: Fetal growth restriction may be the consequence of maternal, fetal, or placental factors. The insulin-like growth factors (IGFs) are major determinants of fetal growth, and are expressed in the mother, fetus and placenta in most species. Previously we reported higher placental protein content of IGF-I, IGF-IR, and AKT in small (SGA) compared with those from appropriate for gestational age (AGA) placentas. The protein Klotho, has been reported in placenta and may regulate IGF-I activity. In this study we determined Klotho gene expression and protein immunostaining in term (T-SGA y T-AGA) and preterm (PT-SGA y PT-AGA) human placentas. In addition, we assessed the effect of Klotho on the IGF-IR and AKT activation induced by IGF-I. Methods: Placentas (n = 1 17) from 32 T-SGA (birth weight (BW) = -1.74 ± 0.08 SDS), 37 T-AGA (BW = 0.12 ± 0.12 SDS), 20 PT-SGA (BW = -2.08 ± 0.14 SDS), and 28 PT-AGA (BW = -0.43 ± 0.13 SDS) newborns were collected. mRNA expression by RT-PCR in the chorionic (CP) and basal (BP) plates of the placentas, and the presence of Klotho was evaluated by immunohistochemistry (integral optical density, IOD). In addition, we developed placental explants that were incubated with IGF-I in the presence or absence of Klotho. Results: We found a lower mRNA expression and protein immunoreactivity of Klotho in the CP of SGA (term and preterm) compared with AGA placentas. We also observed a significant reduction in IGF-IR tyrosine activation induced by IGF-I 10 nM when preincubated with 2.0 nM of Klotho (2.4 ± 0.5 arbitrary units vs. 1.3 ± 0.3 AU), and similar results we observed on AKT and ERK42/44 activation. Conclusion: We describe for the first time that Klotho mRNA and protein varies according to fetal growth and gestational age. In addition, Klotho appears to down-regulate the activation induced by IGF-I on IGF-IR and AKT, suggesting that Klotho may be regulating IGF-I activity in human placentas according to intrauterine fetal growth.

Relationship between folate transporters expression in human placentas at term and birth weights.

BACKGROUND: Adequate folate levels are essential for successful pregnancy outcomes. We aimed to study the relationship between placental mRNA and protein levels of folate transporters to birth weight. METHODS: Placental folate transporters (FOLR1, RFC1 and HCP1/PCFT) mRNA and protein levels in basal (BP) and chorionic plate (CP) of small (SGA), appropriate (AGA) and large (LGA) for gestational age term infants (≥37 weeks gestation, n = 111) were determined by real-time PCR and Western blot respectively. RESULTS: FOLR1 and HCP1/PCFT mRNA were lower in both plates of SGA and LGA placentas compared to AGA (p < 0.01) and RFC1 mRNA was lower only in CP (p < 0.02). RFC1 protein levels were lower in BP of SGA (p < 0.05) and LGA (p < 0.01), and FOLR1 protein levels were lower in CP of SGA (p < 0.02) and LGA (p < 0.01) groups compared to AGA. HCP1/PCFT protein levels remained unchanged in all groups. CONCLUSION: Placentas of SGA and LGA groups showed a reduced mRNA expression and protein levels of folate transporters, with some differences depending on the location within the placenta (BP or CP). This suggests the presence of specific placental regulation mechanisms in gene expression that may be associated to birth weight.

Determination of free cholesterol oxide products in food samples by gas chromatography and accelerated solvent extraction: influence of electron-beam irradiation on cholesterol oxide formation.

BACKGROUND: The aim of this study was to develop an efficient method for cholesterol oxide product (COP) determination in irradiated and non-irradiated ready-to-eat foods with high water content by gas chromatography-flame ionisation detector after accelerated solvent extraction (ASE), and derivatisation with a silylating reagent. RESULTS: The ASE solvent was an 85:15 v/v petroleum ether/chloroform mixture at 40 °C and 1500 psi followed by solid phase extraction. The ASE method was compared with the established lixiviation method, proving an advantageous alternative which reduces analysis time by a factor of 15 and solvent volume by 50%, and minimises the use of chlorinated solvents. COP derivative structures were identified by gas chromatography coupled with mass spectrometry. Analytical characteristics were determined from standards and recoveries were 63-95%, establishing the validity of the method. CONCLUSION: The results obtained and their analysis by chemometric techniques established COP formation in food samples after e-beam irradiation. Increase in COP concentration depended on both irradiation doses and food composition, mainly water and fat content, although linear correlations among variables were not found. © 2016 Society of Chemical Industry.

Determinación de la formación de óxidos de colesterol en el proceso de preparación de frito pastuso usando como técnica de análisis HPLC / Determination of the formation of cholesterol oxides in the process of preparation of frito pastuso using HPLC as the analysis technique

Introducción: Los procesos de preparación de los alimentos inducen a la formación de compuestos nocivos para la salud, entre estos se encuentran los óxidos de colesterol (COPs). Objetivo: Determinar la formación de 25-hidroxicolesterol (5-colesten-3ß,25-diol), 6-cetocolesterol (3ß-hidroxi-5α-colestan-6-ona) y 7-cetocolesterol (3ß-hidroxi-5α-colestan-7-ona), en el proceso de preparación de frito pastuso (alimento típico de Nariño, Colombia). Materiales y métodos: La determinación de los COPs se realizó mediante extracción en fase sólida (SPE) y cromatografía liquida de alta eficiencia (HPLC-UV) en fase reversa. Los factores evaluados fueron: receta de preparación, tipo de grasa o aceite utilizado y tipo de carne de cerdo, aplicando un diseño experimental DCA con tres factores y tres niveles en cada caso, se realizaron 10 ensayos totalmente aleatorizados por duplicado, para verificar la reproducibilidad de los resultados. El análisis de óxidos de colesterol (COPs) se aplicó a los diferentes insumos para la preparación y en el alimento listo para el consumo. Resultados: El 7-cetocolesterol se determinó en la mayoría de las muestras; los niveles más altos se encontraron en las muestras de los experimentos donde se utilizó: carne de costilla, grasa de cerdo y la receta de fritura directa de la carne. Los niveles más bajos se encontraron para los experimentos donde se utilizó lomo y pierna, aceite reutilizado y preparaciones de la carne a cocción en agua y posterior fritura. Conclusiones: Las desviaciones estándar relativas fueron inferiores al 4,76% obteniendo resultados reproducibles. La identificación de óxidos de colesterol en la presente investigación permitió establecer la influencia que tienen las formas de preparación de los alimentos de consumo frecuente, en la formación de compuestos que presentan reconocidos efectos adversos para la salud humana.

Introduction: Food preparation processes lead to the formation of harmful compounds to health, some of these include oxides of cholesterol (COPs). Objective: To determine the formation of 25-hydroxycholesterol (5-cholesten-3ß, 25-diol), 6-cetocolesterol (3ß-hidroxi-5α-colestan-6-ona) and 7-cetocolesterol (3ß-hidroxi-5α-colestan-7-ona) in the process of preparation of "frito pastuso" (a typical dish in Nariño, Colombia). Materials and methods: The COPs were determined by extraction in solid phase (SPE) and liquid chromatography of high efficiency (HPLC-UV) in reversed phase. The evaluated factors were: recipe, type of grease or oil used and type of pork by using a DCA experimental design with three factors and three levels in each case. 10 totally randomized tests were performed in duplicate to check the reproducibility of the results. The analysis of cholesterol oxides (COPs) was applied to different inputs for the preparation and the food ready for consumption. Results: The 7-cetocolesterol was determined in the majority of samples. The highest levels were found in the samples of the experiments which used rib meat, pork fat and direct meat fried recipe. The lowest levels were found for experiments which used loin and leg, reused oil and the recipe where the meat is first cooked in water before frying. Conclusions: The relative standard deviations were lower to 4,76% where reproducible results were obtained. The identification of cholesterol oxides in this research helped to establish the influence that the different ways to prepare food of frequent consumption have on the formation of compounds that have recognized adverse effects on human health.

IGF-IR signal transduction protein content and its activation by IGF-I in human placentas: relationship with gestational age and birth weight.

INTRODUCTION: The human placenta expresses the IGF-I and IGF-IR proteins and their intracellular signal components (IRS-1, AKT and mTOR). The aim of this study was to assess the IGF-IR content and activation of downstream signaling molecules in placentas from newborns who were classified by gestational age and birth weight. We studied placentas from 25 term appropriate (T-AGA), 26 term small (T-SGA), 22 preterm AGA (PT-AGA), and 20 preterm SGA (PT-SGA) newborns. The total and phosphorylated IGF-IR, IRS-1, AKT, and mTOR contents were determined by Western Blot and normalized by actin or with their respective total content. The effect of IGF-I was determined by stimulating placental explants with recombinant IGF-I 10-8 mol/L for 15, 30, and 60 minutes. RESULTS: The IGF-IR content was higher in T-SGA compared to T-AGA placentas, and the IRS-1 content was higher in PT-placentas compared with their respective T-placentas. The effect of IGF-I on the phosphorylated forms of IGF-IR was increased in T-SGA (150%) and PT-SGA (300%) compared with their respective AGA placentas. In addition, AKT serine phosphorylation was higher in PT-SGA compared to PT-AGA and T-SGA placentas (90% and 390% respectively). CONCLUSION: The higher protein content and response to IGF-I of IGF-IR, IRS-1, and AKT observed in SGA placentas may represent a compensatory mechanism in response to fetal growth restriction.

Pronóstico de pacientes con cáncer de mama tratadas con cirugía en un sistema privado extra de salud / Prognosis of patients with breast cancer treated with definitive surgery in a private health insurance system

Introducción: Muchas usuarias del sistema público de salud español contratan además un seguro privado para mejorar los controles ginecológicos y exploraciones rutinarias como mamografía anual. Analizamos retrospectivamente el pronóstico de estas pacientes cuando son diagnosticadas de cáncer de mama y se tratan con cirugía de intención curativa. Material y métodos: Se analizan la supervivencia global y los factores pronósticos de pacientes diagnosticadas de cáncer de mama sin metástasis tratadas con cirugía curativa en el contexto de un tratamiento multidisciplinario, remitidas a una consulta de oncología médica dentro de un sistema sanitario privado extra. Resultados: Entre 1994 y 2009 se analizaron 395 pacientes con cáncer de mama. Treinta y ocho tenían metástasis al diagnóstico y 357 pudieron tratarse con cirugía curativa: conservadora en 265 casos y mastectomía en 92. Con mediana de seguimiento de 64 meses, la tasa de supervivencia a 5 años era 91%: 97% para estadios I, 94% para estadios II, y 77% para estadios III. En las que se diagnosticaron por mamografía sistemática fue del 96 frente al 86% en las que acudieron al ginecólogo por autopalpación de tumor u otros síntomas (p = 0,0159). En el 74% se realizo ́ tratamiento conservador con mejor supervivencia frente al 26% que se realizó mastectomía (p = 0,0024). Pacientes con receptores positivos tuvieron mejor supervivencia que con receptores negativos (p = 0,0264) y este fue el único factor pronóstico independiente en el análisis multivariado de Cox. Conclusiones: Las pacientes con cáncer de mama tratadas con cirugía de intención curativa en un sistema sanitario privado tienen alta tasa de curación probablemente por tener un diagnóstico en fase precoz (AU)

Introduction: Many women enrolled in the Spanish National Health Service also take out private health insurance to improve gynecological follow-up and complementary examinations, such as annual mammograms. We analyzed the cure rate of these patients when diagnosed with breast cancer and treated with surgery with curative intent. Material and methods: Both overall survival and prognosis were analyzed in patients with breast cancer without metastases referred to a private oncology facility and treated with definitive surgery in the context of multidisciplinary treatment. Results: Between 1994 and 2009, 395 patients with breast cancer were analyzed. Thirty- eight had metastases at diagnosis and 357 could be treated with definitive surgery: conservative in 265 patients and mastectomy in the remaining 92. The median follow-up was 64 months and the 5-year survival rate was 91%: 97% for stage I, 94% for stage II and 77% for stage III. In women diagnosed by mammography, the 5-year survival rate was 96% versus 86% for women consulting a gynecologist after self palpation or for other symptoms (p = 0.0159). Treatment was conservative in 74%, with better survival than in the remaining 26% who were treated with mastectomy (p = 0.0024). Survival was greater in patients with positive hormone receptors than in those with negative hormone receptors (p = 0.0264). Hormone receptor status was the only independent prognostic factor in multivariate Cox analysis. Conclusions: Patients with breast cancer treated with definitive surgery in a private health insurance system have high cure rate, possibly because they are diagnosed in an early stage (AU)

Escenarios del 85: entre la estabilización y las elecciones / sss

El Centro de Investigación y Consultoría (CINCO), se propuso reunir a un pequeño pero destacado grupo de economistas, de distintas vertientes de pensamiento, para efectuar un diálogo que tenga como objetivo realizar un diagnóstico de la situación económica y política nacional y evaluar sus perspectivas más probables durante 1985. La crisis económica, es de tal gravedad que sólo una nueva política que surja de un elemental y definido consenso podrá conquistar la solidaridad necesaria para enfrentar y superar la pesada situación que atravesamos