Predictive validity of a pressure injury risk assessment tool at different time-points in patients admitted to the intensive care unit.

BACKGROUND: Multiple risk assessment scales are available for predicting the development of pressure injuries (PIs) in patients in the intensive care unit (ICU). Most PI risk assessment tools have been validated at the time of admission; however, another time point during treatment could better reflect clinical changes and therefore, the risk of PIs. AIMS: The study aimed to examine the predictive validity of PI risk assessment scale designed for ICU patients, the conscious level, mobility, haemodynamic, oxygenation and nutrition (COMHON) index, at several time points or intervals during ICU stay. STUDY DESIGN: This was an observational prospective study undertaken over a period of 1 year (July 2021-June 2022). Patients admitted to ICU for >3 days were included. The number, location and degree of the PIs were recorded. The level of risk for developing PIs during the stay was determined by calculating the COMHON scores at admission, and 72 h, as well as the highest and mean score. Predictive validity was studied using accuracy parameters and areas under the receiver operating characteristic curve (AUC). The best cutoff point was also determined and used to compare risk between categories. RESULTS: Of the 286 patients included in the study, 160 (59%) were male. The level of severity evaluated using the APACHE II scale was 18.4 ± 5.8 points. Invasive mechanical ventilation was used in 32.1% (n = 92) of the patients and 20.6% (n = 59) received high flow oxygen therapy. The incidence of PI was 15.4% (n = 44), with sacral location in 47.7% (n = 21) and grade II in 75% (n = 33) of the patients. The AUC was 0.907 (0.872-0.942); 0.881 (0.842-0.920); 0.877 (0.835-0.920) and 0.749 (0.667-0.831) at the mean, the highest, 72 h and ICU admission scores, respectively. The best cutoff point was 13 in all patients. The risk of developing a PI was 6.4 times higher in the high-risk group (>13 points). CONCLUSIONS: The best predictive capacity for the COMHON index risk assessment was the mean and highest scores. The predictive accuracy was higher on the third day of the patient's stay than on admission, and this was attributed to the clinical changes observed in some patients over the course of their critical illness. RELEVANCE FOR CLINICAL PRACTICE: Patients in ICU are at high risk of developing PIs, therefore, preventive measures should be maximized. Risk assessment should be carried out sequentially owing to the changes that patients present throughout their ICU stay and preventive measures should be used according to the risk level.

Clinical, glycometric features and treatment in a family with monogenic diabetes due to a new mutation in the insulin gene.

Monogenic diabetes caused by changes in the gene that encodes insulin (INS) is a very rare form of monogenic diabetes (<1%). The aim of this work is to describe the clinical and glycaemic control characteristics over time from four members of a family diagnosed with monogenic diabetes with the novel mutation: c.206del,p.(Gly69Aalfs*62) located in exon 3 of the gene INS. 75% are females, with debut in adolescence and negative autoimmunity. In all cases, C-peptide is detectable decades after diagnosis (>0.6ng/ml). Currently, patients are being treated either with insulin in a bolus-basal regimen, oral antidiabetics or hybrid closed loop system. Monogenic diabetes due to mutation in the INS is an entity with heterogeneous presentation, whose diagnosis requires high suspicion and presents an important clinical impact. Given the lack of standards in this regard, therapy must be individualized, although insulin therapy could help preserve beta cell functionality in these subjects.

Clinical Evaluation of an Artificial Intelligence-Based Decision Support System for the Diagnosis and American College of Radiology Thyroid Imaging Reporting and Data System Classification of Thyroid Nodules.

Background: This study aimed to evaluate the clinical impact of an artificial intelligence (AI)-based decision support system (DSS), Koios DS, on the analysis of ultrasound imaging and suspicious characteristics for thyroid nodule risk stratification. Methods: A retrospective ultrasound study was conducted on all thyroid nodules with histological findings from June 2021 to December 2022 in a thyroid nodule clinic. The diagnostic performance of ultrasound imaging was evaluated by six readers on the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) before and after the use of the AI-based DSS and by AI itself. Results: A total of 172 patients (83.1% women) with a mean age of 52.3 ± 15.3 years were evaluated. The mean maximum nodular diameter was 2.9 ± 1.2 cm, with 11.0% being differentiated thyroid carcinomas. Among the nodules initially classified as ACR TI-RADS 3 and 4, AI reclassified 81.4% and 24.5% into lower risk categories, respectively. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the readers and the AI-based DSS versus histological diagnosis. There was an increase in the area under the ROC curve (AUROC) after the use of AI (0.776 vs. 0.817, p < 0.001). The AI-based DSS improved the mean sensitivity (Sens) (82.3% vs. 86.5%) and specificity (Spe) (38.3% vs. 54.8%), produced a high negative predictive value (94.5% vs. 96.4%), and increased the positive predictive value (PPV) (14.0% vs. 16.1%) and diagnostic precision (43.0% vs. 49.3%). Based on the ACR TI-RADS score, there was significant improvement in interobserver agreement after the use of AI (r = 0.741 for ultrasound imaging alone vs. 0.981 for ultrasound imaging and the AI-based DSS, p < 0.001). Conclusions: The use of an AI-based DSS was associated with overall improvement in the diagnostic efficacy of ultrasound imaging, based on the AUROC, as well as an increase in Sens, Spe, negative and PPVs, and diagnostic accuracy. There was also a reduction in interobserver variability and an increase in the degree of concordance with the use of AI. AI reclassified more than half of the nodules with intermediate ACR TI-RADS scores into lower risk categories.

Maximal Respiratory Pressure Reference Equations in Healthy Adults and Cut-off Points for Defining Respiratory Muscle Weakness.

INTRODUCTION: Maximal inspiratory and expiratory pressures (PImax/PEmax) reference equations obtained in healthy people are needed to correctly interpret respiratory muscle strength. Currently, no clear cut-off points defining respiratory muscle weakness are available. We aimed to establish sex-specific reference equations for PImax/PEmax in a large sample of healthy adults and to objectively determine cut-off points for respiratory muscle weakness. METHODS: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy non-smoking volunteers aged 18-80 years stratified by sex and age were recruited. PImax/PEmax were assessed using uniform methodology according to international standards. Multiple linear regressions were used to obtain reference equations. Cut-off points for respiratory muscle weakness were established by using T-scores. RESULTS: The final sample consisted of 610 subjects (314 females; 48 [standard deviation, SD: 17] years). Reference equations for PImax/PEmax included body mass index and a squared term of the age as independent variables for both sexes (p<0.01). Cut-off points for respiratory muscle weakness based on T-scores ≥2.5 SD below the peak mean value achieved at a young age were: 62 and 83cmH2O for PImax and 81 and 109cmH2O for PEmax in females and males, respectively. CONCLUSION: These reference values, based on the largest dataset collected in a European population to date using uniform methodology, help identify cut-off points for respiratory muscle weakness in females and males. These data will help to better identify the presence of respiratory muscle weakness and to determine indications for interventions to improve respiratory muscle function.

Glycemia Risk Index Assessment in a Pediatric and Adult Patient Cohort With Type 1 Diabetes Mellitus.

BACKGROUND: To evaluate the glycemia risk index (GRI) as a new glucometry in pediatric and adult populations with type 1 diabetes (T1D) in clinical practice. METHODS: A cross-sectional study of 202 patients with T1D receiving intensive treatment with insulin (25.2% continuous subcutaneous insulin infusion [CSII]) and intermittent scanning (flash) glucose monitoring (isCGM). Clinical and glucometric isCGM data were collected, as well as the component of hypoglycemia (CHypo) and component of hyperglycemia (CHyper) of the GRI. RESULTS: A total of 202 patients (53% males and 67.8% adults) with a mean age of 28.6 ± 15.7 years and 12.5 ± 10.9 years of T1D evolution were evaluated.Adult patients (>19 years) presented higher glycated hemoglobin (HbA1c) (7.4 ± 1.1 vs 6.7 ± 0.6%; P < .01) and lower time in range (TIR) (55.4 ± 17.5 vs 66.5 ± 13.1%; P < .01) values than the pediatric population, with lower coefficient of variation (CV) (38.6 ± 7.2 vs 42.4 ± 8.9%; P < .05). The GRI was significantly lower in pediatric patients (48.0 ± 22.2 vs 56.8 ± 23.4; P < .05) associated with higher CHypo (7.1 ± 5.1 vs 5.0 ± 4.5; P < .01) and lower CHyper (16.8 ± 9.8 vs 26.5 ± 15.1; P < .01) than in adults.When analyzing treatment with CSII compared with multiple doses of insulin (MDI), a nonsignificant trend to a lower GRI was observed in CSII (51.0 ± 15.3 vs 55.0 ± 25.4; P= .162), with higher levels of CHypo (6.5 ± 4.1 vs 5.4 ± 5.0; P < .01) and lower CHyper (19.6 ± 10.6 vs 24.6 ± 15.2; P < .05) compared with MDI. CONCLUSIONS: In pediatric patients and in those with CSII treatment, despite a better control by classical and GRI parameters, higher overall CHypo was observed than in adults and MDI, respectively. The present study supports the usefulness of the GRI as a new glucometric parameter to evaluate the global risk of hypoglycemia-hyperglycemia in both pediatric and adult patients with T1D.

Intensive complex physical therapy combined with intermittent pneumatic compression versus Kinesio taping for treating breast cancer-related lymphedema of the upper limb: A randomised cross-over clinical trial.

OBJECTIVE: The objective of this study is to compare the effectiveness of complex physical therapy combined with intermittent pneumatic compression (CPT + IPC) versus Kinesio taping (KT) for breast cancer-related lymphedema. METHODS: A cross-over clinical trial was conducted in 43 women with lymphedema. All participants received two interventions: CPT + IPC and KT, both lasting 3 weeks and a washout period. The main outcome variable was the relative volume change (RVC). The secondary variables were Satisfaction Questionnaire about Textile Therapeutic Devices used for Breast Cancer-Related Lymphedema, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, motion range of upper limb and lymphedema-related symptoms. RESULTS: The RVC reduction was greater with CPT + IPC (-2.2%, SD = 4.7) versus KT (-0.9%, SD = 1.7) (P = 0.002). KT was more satisfactory than multilayer bandaging (8.9 points difference, P < 0.001) and improved DASH score more than CPT + IPC (14.3 points difference, P = 0.002). Regarding motion ranges, only shoulder movements showed significant improvement with CPT + IPC compared with KT (differences between 5.6° and 11.4°). Of the symptoms assessed, only pain reduction showed a significant improvement with KT versus CPT + IPC (0.5 points, P = 0.035). CONCLUSIONS: CPT + IPC achieved higher RVC and greater improvement in th shoulder motion range than KT. Conversely, KT was more satisfactory than multilayer bandaging, obtained better DASH scores and relieved pain more than CPT + IPC. CLINICAL REGISTRATION: ClinicalTrial registration number: NCT03051750 (date of registration 14 February 2017).

Development and Evaluation of a Satisfaction Questionnaire About Therapeutic Textile Devices Used for Breast Cancer-Related Lymphedema.

Background: There is a need for an appropriate instrument to measure the satisfaction of patients about therapeutic textile devices used for breast cancer-related lymphedema (BCRL). Methods and Results: A new satisfaction questionnaire about therapeutic textile devices used for BCRL was developed and psychometrically tested. An approach to criterion validity by contrast of hypothesis was made. Different average scores were expected depending on the type of therapeutic textile device: Kinesio taping, compression garment, and multilayer low-stretch bandage. Items were analyzed in nine phases: apparent validity, missing responses, internal consistency, factor analysis, reproducibility, confirmation of factor analysis, contrast of hypothesis, variability, and time for completion. One hundred fifty women were sampled in a consecutive order. A final questionnaire was drafted that fulfilled the validation hypothesis, including 20 items that explored 4 dimensions: mood, patient comfort, patient compliance, and perceived benefits. The total Cronbach's α was 0.87. The intraclass correlation coefficient was 0.93 for test-retest and 0.91 for inter-rater. Neither ceiling nor floor effects were observed. The average burden for the respondent and interviewer was 5.6 (standard deviation [SD] = 3.8) and 2.2 (SD = 1.3) minutes, respectively. Conclusion: This preliminary analysis supports the content validity, reliability, and validity of construct of the questionnaire.

Agreement of blood glucose measured with glucose meter in arterial, central venous, and capillary samples in adult critically ill patients.

BACKGROUND: The measurement of blood glucose in critically ill patients is still performed in many ICUs with glucose meters and capillary samples. Several prevalent factors in these patients affect the accuracy of the results and should be interpreted with caution. A weak recommendation from the Surviving Sepsis Campaign (SSC) suggests the use of arterial blood rather than capillary blood for point of care testing using glucose meters. AIMS AND OBJECTIVES: To analyse the agreement between arterial, central venous, and capillary blood samples of glucose values measured by glucose meter in critically ill patients and study potential confounding factors. DESIGN: Prospective cross-sectional study in a general intensive care unit (ICU). Patients needing insulin treatment (subcutaneous or intravenous) and blood glucose control were included. METHODS: Standardized collection of blood samples and measurement of glucose values with a glucometer. Agreement was studied by the Bland-Altman method and stratified analysis of disagreement-survival plots was used to study the influence of haematocrit, pH range, SOFA score, capillary refilling time, intravenous insulin infusion, and lactic acid. RESULTS: A total of 297 measurements from 54 patients were included. The mean arterial blood glucose was 150.42 (range 31-345 mg/dL). In the graphical analysis, there is a poor agreement both in capillary and venous central to arterial samples, but in opposite direction (underestimation of capillary and overestimation of central venous). Factors associated with a reduction in the agreement between arterial and capillary samples were elevated lactate, poor capillary refilling, and hemodynamic failure. Patients without hemodynamic compromise have an acceptable agreement with values for absolute differences of 16 mg/dL for a disagreement of 10%. CONCLUSIONS: In critically ill patients, the measurement of blood glucose with a glucose meter should be performed with arterial samples whenever possible. Capillary samples do not accurately estimate arterial blood glucose values in patients with shock and/or vasoactive drugs and underestimate the values in the range of hypoglycemia. Venous samples are subject to error because of potential contamination. RELEVANCE TO CLINICAL PRACTICE: This study adds support to the recommendation of using arterial blood rather than capillary or venous blood when using glucose meters in critically ill patients, especially in those with hemodynamic failure.

Un estudio en la vida real para evaluar un suplemento oral peptídico en adultos con alteración de la función intestinal tras la nutrición parenteral / A real-world study to evaluate a peptidic oral supplement in adults with altered intestinal function after parenteral nutrition

OBJETIVOS: en la práctica clínica habitual existen multitud de situaciones y patologías que pueden interrumpir la digestión y la absorción intestinal, cursando con desnutrición y requiriendo el uso de suplementos orales nutricionales (SON). El objetivo de nuestro estudio fue evaluar, en el contexto de la vida real, el uso de un SON basado en péptidos, y el cumplimiento con el mismo, en pacientes adultos desnutridos con compromiso intestinal tras más de 14 días de nutrición parenteral. MATERIAL Y MÉTODOS: el estudio se realizó en 44 pacientes desnutridos que requirieron nutrición parenteral total al menos 14 días, sin utilización de la vía oral durante el ingreso hospitalario. A todos los pacientes se les administró de manera ambulatoria 1 brik al día de Vital 1.5(R) para su consumo durante 12 semanas. Al inicio del tratamiento y tras el periodo de intervención se les recogieron las variables siguientes: peso, talla, índice de masa corporal (IMC), test de valoración subjetiva global, bioquímica nutricional, encuesta nutricional, efectos adversos generados por la fórmula y cumplimentación. RESULTADOS: se incluyeron 44 pacientes con una edad media de 70,4 ± 10,4 años (20 mujeres/24 hombres). Tras la intervención aumentaron el IMC (0,51 ± 0,1 kg/m2; p = 0,02), el peso (1,4 ± 0,3 kg; p = 0,03), la prealbúmina (3,5 ± 4,1 mg/dl; p = 0,01), la albúmina (1,3 ± 0,1 mg/dl; p = 0,03) y la transferrina (71,5 ± 24,1 mg/dl; p = 0,02). La toma del SON represento a los 3 meses un 14,4 % del aporte calórico total de la dieta, un 17,5 % de los hidratos de carbono, un 12,9 % de las proteínas y un 12,3 % de las grasas. La cumplimentación media del grupo fue del 87,7 ± 7,2 % de las tomas prescritas. En relacion a la situacion nutricional, a la entrada del estudio un 52,3 % (n = 23) de los pacientes presentaban en el test de valoración subjetiva global la categoría B (malnutrición moderada o riesgo nutricional) y un 47,7 % (n = 21) la categoría C (desnutrición severa). Tras la intervención, un 75 % de los pacientes presentaban la categoría A (buena situación nutricional (n = 33), un 13,6 % (n = 6) de los pacientes presentaban la categoría B y un 11,4 % (n = 5) la categoría C. CONCLUSIONES: la utilización de un suplemento peptídico con triglicéridos de cadena corta en pacientes ambulatorios tras haber recibido una nutrición parenteral total muestra un efecto beneficioso sobre los parametros bioquímicos y antropométricos, y la situación nutricional, con una alta cumplimentación y buena tolerancia

OBJECTIVES: in routine clinical practice many disorders are found that can disrupt the sequence of reactions in digestion and absorption, leading to malnutrition and requiring the use of oral nutritional supplements (ONS). The objective of our study was to evaluate in a real world setting the use of and compliance with a peptide-based ONS in malnourished adult patients with intestinal compromise after more than 14 days of parenteral nutrition. MATERIAL AND METHODS: the study was carried out in 44 malnourished patients who required total parenteral nutrition for at least 14 days without using the oral route during their hospital stay. All patients were administered, on an outpatient basis, 1 brick per day of Vital 1.5(R) for 12 weeks. At the beginning of treatment and after the intervention period evaluated, the following variables were collected: weight, height, body mass index (BMI), global subjective assessment test, nutritional biochemistry, 3-day nutritional survey, adverse effects generated by the formula, and completion rate. RESULTS: 44 patients were enrolled. Mean age was 70.4 ± 10.4 years (20 women & 24 men). After the intervention the following parameters had increased: BMI (0.51 ± 0.1 kg/m2; p = 0.02), weight (1.4 ± 0.3 kg; p = 0.03), prealbumin (3.5 ± 4.1 mg/dl; p = 0.01), albumin (1.3 ± 0.1 mg/dl; p = 0.03), and transferrin (71.5 ± 24.1 mg/dl; p = 0.02). Dietary intake of the ONS represented 14.4 % of the diet's total caloric intake at 3 months, 17.5 % of carbohydrates, 12.9 % of proteins, and 12.3 % of fats. Mean compliance was 87.7 ± 7.2 % of the prescribed intakes. In relation to the nutritional situation, at the beginning of the study, 52.3 % (n = 23) of patients were in the global subjective assessment test in category B (moderate malnutrition or nutritional risk), and 47.7 % (n = 21) in category C (severe malnutrition). After the intervention, 75 % of patients were in category A (n = 33), 13.6 % (n = 6) in category B, and 11.4 % (n = 5) in category C. CONCLUSIONS: the use of a peptide-based ONS with short-chain triglycerides in outpatients showed a beneficial effect on biochemical and anthropometric parameters, and improved the nutritional status of patients with high compliance and good tolerance rates

[A real-world study to evaluate a peptidic oral supplement in adults with altered intestinal function after parenteral nutrition]. / Un estudio en la vida real para evaluar un suplemento oral peptídico en adultos con alteración de la función intestinal tras la nutrición parenteral.

INTRODUCTION: Objectives: in routine clinical practice many disorders are found that can disrupt the sequence of reactions in digestion and absorption, leading to malnutrition and requiring the use of oral nutritional supplements (ONS). The objective of our study was to evaluate in a real world setting the use of and compliance with a peptide-based ONS in malnourished adult patients with intestinal compromise after more than 14 days of parenteral nutrition. Material and methods: the study was carried out in 44 malnourished patients who required total parenteral nutrition for at least 14 days without using the oral route during their hospital stay. All patients were administered, on an outpatient basis, 1 brick per day of Vital 1.5® for 12 weeks. At the beginning of treatment and after the intervention period evaluated, the following variables were collected: weight, height, body mass index (BMI), global subjective assessment test, nutritional biochemistry, 3-day nutritional survey, adverse effects generated by the formula, and completion rate. Results: 44 patients were enrolled. Mean age was 70.4 ± 10.4 years (20 women & 24 men). After the intervention the following parameters had increased: BMI (0.51 ± 0.1 kg/m2; p = 0.02), weight (1.4 ± 0.3 kg; p = 0.03), prealbumin (3.5 ± 4.1 mg/dl; p = 0.01), albumin (1.3 ± 0.1 mg/dl; p = 0.03), and transferrin (71.5 ± 24.1 mg/dl; p = 0.02). Dietary intake of the ONS represented 14.4 % of the diet's total caloric intake at 3 months, 17.5 % of carbohydrates, 12.9 % of proteins, and 12.3 % of fats. Mean compliance was 87.7 ± 7.2 % of the prescribed intakes. In relation to the nutritional situation, at the beginning of the study, 52.3 % (n = 23) of patients were in the global subjective assessment test in category B (moderate malnutrition or nutritional risk), and 47.7 % (n = 21) in category C (severe malnutrition). After the intervention, 75 % of patients were in category A (n = 33), 13.6 % (n = 6) in category B, and 11.4 % (n = 5) in category C. Conclusions: the use of a peptide-based ONS with short-chain triglycerides in outpatients showed a beneficial effect on biochemical and anthropometric parameters, and improved the nutritional status of patients with high compliance and good tolerance rates.

INTRODUCCIÓN: Objetivos: en la práctica clínica habitual existen multitud de situaciones y patologías que pueden interrumpir la digestión y la absorción intestinal, cursando con desnutrición y requiriendo el uso de suplementos orales nutricionales (SON). El objetivo de nuestro estudio fue evaluar, en el contexto de la vida real, el uso de un SON basado en péptidos, y el cumplimiento con el mismo, en pacientes adultos desnutridos con compromiso intestinal tras más de 14 días de nutrición parenteral. Material y métodos: el estudio se realizó en 44 pacientes desnutridos que requirieron nutrición parenteral total al menos 14 días, sin utilización de la vía oral durante el ingreso hospitalario. Se les administró de manera ambulatoria 1 brik al día de Vital 1.5® para su consumo durante 12 semanas. Al inicio del tratamiento y tras el periodo de intervención se les recogieron las variables siguientes: peso, talla, IMC, test de valoración subjetiva global, bioquímica nutricional, encuesta nutricional, efectos adversos generados por la fórmula y cumplimentación. Resultados: se incluyeron 44 pacientes con una edad media de 70,4 ± 10,4 años (20 mujeres/24 hombres). Tras la intervención aumentaron el IMC (0,51 ± 0,1 kg/m2; p = 0,02), el peso (1,4 ± 0,3 kg; p = 0,03), la prealbúmina (3,5 ± 4,1 mg/dl; p = 0,01), la albúmina (1,3 ± 0,1 mg/dl; p = 0,03) y la transferrina (71,5 ± 24,1 mg/dl; p = 0,02). La toma del SON represento a los 3 meses un 14,4 % del aporte calórico total de la dieta, un 17,5 % de los hidratos de carbono, un 12,9 % de las proteínas y un 12,3 % de las grasas. La cumplimentación media del grupo fue del 87,7 ± 7,2 % de las tomas prescritas. En relacion a la situacion nutricional, a la entrada del estudio un 52,3 % (n = 23) de los pacientes presentaban en el test de valoración subjetiva global la categoría B (malnutrición moderada o riesgo nutricional) y un 47,7 % (n = 21) la categoría C (desnutrición severa). Tras la intervención, un 75 % de los pacientes presentaban la categoría A (buena situación nutricional (n = 33), un 13,6 % (n = 6) de los pacientes presentaban la categoría B y un 11,4 % (n = 5) la categoría C. Conclusiones: la utilización de un suplemento peptídico con triglicéridos de cadena corta en pacientes ambulatorios tras haber recibido una nutrición parenteral total muestra un efecto beneficioso sobre los parametros bioquímicos y antropométricos, y la situación nutricional, con una alta cumplimentación y buena tolerancia.

A Practical Overview on the Molecular Biology of Meningioma.

PURPOSE OF REVIEW: Meningioma is a common intracranial neoplasm currently classified in 15 histologic subtypes across 3 grades of malignancy. First-choice therapy for meningioma is maximum safe resection for grade I tumors, and surgery plus optional and mandatory adjuvant radiotherapy for grade II and III, respectively, given the increased rate of recurrence even in the event of complete resection. The WHO 2016 histopathologic grading of meningioma has been questioned due to subjectivity and its controversial predictive power for recurrence. RECENT FINDINGS: Novel DNA methylation profiling has simplified classification into six classes that seem to improve prognostic accuracy. We review five main topics of molecular biology research regarding tumorigenesis and natural history of meningioma from the clinician's perspective: the histopathologic diagnostic features and pitfalls of the current tumor classification; the molecular integrated diagnosis supported by identification of genetic alterations and DNA methylation profiling; the general landscape of the various signaling pathways involved in meningioma formation; the pathogenic theories of the peri-tumoral edema present in meningioma and its therapy implications; and a summarized review on the current treatments and plausible targeted therapies directed to meningioma. It seems likely that molecular assessment will be introduced within the next update of the WHO classification of meningiomas, acknowledging the promising value of DNA methylation profiling. This integrated diagnostic protocol will simplify tumor subtype categorization and provide improved accuracy in predicting recurrence and outcome. Although much effort is being done in identifying key gene mutations, and elucidating specific intracellular signaling pathways involved in meningioma tumorigenesis, effective targeted therapies for recurrent meningiomas are still lacking.

Efecto de una dieta de patrón mediterráneo en la respuesta metabólica secundaria a la pérdida de peso; papel del polimorfismo de un único nucleótido (rs16147) del gen del neuropéptido Y / Effect of a Mediterranean-pattern diet on the metabolic response secondary to weight loss; role of the single nucleotide polymorphism (rs16147) of neuropeptide Y

INTRODUCCIÓN Y OBJETIVOS: los estudios de intervención que evalúan el efecto del rs16147 sobre la respuesta metabólica y el cambio de peso después de una intervención dietética son escasos. En este trabajo evaluamos el papel de la variante genética rs16147 en los efectos metabólicos que produce una dieta hipocalórica de patrón mediterráneo y alto contenido en omega-9. MATERIAL Y MÉTODOS: se reclutó una muestra de 363 sujetos obesos. En la visita basal, los pacientes se asignaron aleatoriamente, durante 12 semanas, a recibir una de dos dietas: dieta M, de patrón mediterráneo, o dieta C, hipocalórica estándar. En todos ellos se determinaron, en el momento basal y a las 12 semanas, una serie de variables bioquímicas y antropométricas, realizándose el genotipado de la variante rs16147. RESULTADOS: en todos los sujetos y con ambas dietas mejoraron los parámetros de adiposidad, tensión arterial y leptina circulante. En los sujetos obesos con el alelo menor (A), los niveles de insulina (GG vs. GA + AA) (-0,9 ± 1,1 UI/L vs. -4,4 ± 1,0 UI/L; p = 0,01) y HOMA-IR (-0,3 ± 0,1 unidades vs. -1,2 ± 0,3 unidades; p = 0,02) disminuyeron significativamente con la dieta M. Los sujetos portadores del alelo menor tras la dieta C mostraron una disminución significativa de los niveles de insulina basal (GG vs. GA + AA) (0,7 ± 0,3 UI/L vs. -2,2 ± 0,9 UI/L: p = 0,02) y HOMA-IR (-0,3 ± 0,2 unidades vs. -0,7 ± 0,1 unidades: p = 0,01). Esta disminución de los niveles de insulina circulante y HOMA-IR en los pacientes con alelo A fue significativamente superior con la dieta M que con la dieta S. CONCLUSIONES: el alelo A de la variante rs16147 se relaciona con una mejor respuesta metabólica, en términos de resistencia a la insulina e insulina basal secundaria a la pérdida de peso, a dos dietas hipocalóricas, siendo superior el efecto obtenido con una dieta de patrón mediterráneo

BACKGROUND AND AIMS: intervention studies that evaluate the effect of rs16147 on metabolic response and weight change after dietary intervention are scarce. We propose to evaluate the role of the rs16147 genetic variant in the metabolic effects produced by a hypocaloric Mediterranean-pattern diet with high content of omega-9. MATERIAL AND METHODS: a sample of 363 obese subjects was recruited. At the baseline visit the patients were randomly assigned to one of two hypocaloric diets for 12 weeks (diet M, Mediterranean pattern; diet C, standard hypocaloric). All patients, at baseline and at 12 weeks, had biochemical and anthropometric variables measured, and genotyping performed for the rs16147 variant. RESULTS: in all subjects, and with both diets, the parameters of adiposity, blood pressure, and circulating leptin improved. In obese subjects with allele (A) insulin levels (GG vs. GA + AA) (-0.9 ± 1.1 IU/L vs. -4.4 ± 1.0 IU/L; p = 0.01) and HOMA-IR (-0.3 ± 0.1 units vs. -1.2 ± 0.3 units; p = 0.02) decreased significantly with diet M. Subjects carrying the minor allele showed a significant decrease in basal insulin levels (GG vs. GA + AA) (0.7 ± 0.3 IU/L vs. -2.2 ± 0.9 IU/L: p = 0.02) and HOMA-IR (-0.3 ± 0.2 units vs. -0.7 ± 0.1 units: p = 0.01) after diet C. This decrease in circulating insulin and HOMA-IR levels in patients with allele A was significantly higher with diet M than with diet C. CONCLUSIONS: the A allele of the rs16147 variant produces a better metabolic response in terms of insulin resistance and basal insulin secondary to weight loss with two different hypocaloric diets in obese subjects, with improvement being higher with the Mediterranean diet

ACYL-CoA synthetase long-chain 5 polymorphism is associated with weight loss and metabolic changes in response to a partial meal-replacement hypocaloric diet / El polimorfismo de la ACYL-CoA-sintetasa de cadena larga 5 se asocia a pérdida de peso y cambios metabólicos en respuesta a una dieta hipocalórica parcial de reemplazo

BACKGROUND: we hypothesize that the acyl CoA synthetase 5 (ACSL5) genotype may influence weight loss secondary to energy restriction. AIMS: the aim of our study was to analyze the effects of the rs2419621 genetic variant of the ACSL5 gene on weight change and metabolic parameters after a partial meal-replacement hypocaloric diet. METHODS: this was a non-randomized, single-treatment study with a formula-diet in 44 obese subjects with body mass index (BMI) greater than 35 kg/m2. Patients received nutritional education and a modified diet with two intakes of a normocaloric hyperproteic formula during 3 months. Anthropometric parameters and biochemical profile were measured at baseline and after 3 months. The rs2419621 variant of the ACSL5 gene was assessed using real-time polymerase chain reaction. RESULTS: T-allele carriers showed greater improvement in body weight (CC vs. CT + TT; -7.4 ± 2.1 kg vs. -9.3 ± 1.8 kg; p = 0.01), body mass index (-3.1 ± 0.4 kg/m2 vs. -3.4 ± 0.5 kg/m2; p = 0.02), fat mass (-5.2 ± 1.4 kg vs. -6.4 ± 1.2 kg; p = 0.01) and waist circumference (-6.1 ± 1.1 cm vs. -8.6 ± 0.8 cm; p = 0.02) than non-T-allele carriers. Only subjects with the T allele showed significant improvement in triglyceride levels (-4.6 ± 2.4 md/dL vs. -14.4 ± 2.3 mg/dL; p = 0.01). Finally, improvements in insulin (-2.0 ± 0.3 mU/L vs. -4.5 ± 0.5 mU/L; p = 0.01) and HOMA-IR (-0.4 ± 0.2 units vs. -1.3 ± 0.3 units; p = 0.02) were higher in T-allele carriers than in non-T-allele carriers. CONCLUSIONS: our data suggest that the genetic variant (rs2419621) of the ACSL5 gene is associated with diet response after a partial-meal replacement intervention, with greater improvements in adiposity and biochemical parameters in subjects with the T allele

ANTECEDENTES: se hipotetiza que el genotipo de la acil-CoA-sintetasa 5 (ACSL5) podría influir en la pérdida de peso secundaria a la restricción de energía. OBJETIVOS: el objetivo de nuestro estudio fue analizar los efectos de la variante genética rs2419621 del gen ACSL5 sobre el cambio de peso y los parámetros metabólicos después de una dieta hipocalórica parcial de reemplazo. MÉTODOS: estudio no aleatorizado, de centro único, con una fórmula dietética, en 44 sujetos obesos con un índice de masa corporal (IMC) superior a 35 kg/m2. Los pacientes recibieron educación nutricional y una dieta modificada con dos tomas de una fórmula hiperproteica normocalórica durante 3 meses. Los parámetros antropométricos y el perfil bioquímico se determinaron en el tiempo basal y tras 3 meses. La variante rs2419621 del gen ACSL5 se evaluó mediante reacción en cadena de la polimerasa en tiempo real. RESULTADOS: los portadores del alelo T mostraron mejorías de peso corporal (CC vs. CT + TT; -7,4 ± 2,1 kg vs. -9,3 ± 1,8 kg; p = 0,01), índice de masa corporal (-3,1 ± 0,4 kg/m2 vs. -3,4 ± 0,5 kg/m2; p = 0,02), masa grasa (-5,2 ± 1,4 kg vs. -6,4 ± 1,2 kg; p = 0,01) y circunferencia de la cintura (-6,1 ± 1,1 cm vs. -8,6 ± 0,8 cm; p = 0,02) superiores a las de los portadores de alelos distintos de T. Solo los sujetos con alelo T mostraron una mejoría significativa en los niveles de triglicéridos (-4,6 ± 2,4 md/dL vs. -14,4 ± 2,3 mg/dL; p = 0,01). Por último, la mejoría de la insulina (-2,0 ± 0,3 mU/L vs. -4.5 ± 0.5 mU/L; p = 0,01) y HOMA-IR (-0,4 ± 0,2 unidades vs. -1,3 ± 0,3 unidades; p = 0,02) fueron mayores en los portadores de alelos T que en los portadores de alelos no T. CONCLUSIONES: nuestros resultados sugieren que la variante genética (rs2419621) del gen ACSL5 está asociada a la respuesta a la dieta después una dieta hipocalórica parcial de reemplazo, con una mejoría superior de los parámetros relacionados con la adiposidad y los parámetros bioquímicos en los sujetos con alelo T

[Effect of a Mediterranean-pattern diet on the metabolic response secondary to weight loss; role of the single nucleotide polymorphism (rs16147) of neuropeptide Y]. / Efecto de una dieta de patrón mediterráneo en la respuesta metabólica secundaria a la pérdida de peso; papel del polimorfismo de un único nucleótido (rs16147) del gen del neuropéptido Y.

INTRODUCTION: Background and aims: intervention studies that evaluate the effect of rs16147 on metabolic response and weight change after dietary intervention are scarce. We propose to evaluate the role of the rs16147 genetic variant in the metabolic effects produced by a hypocaloric Mediterranean-pattern diet with high content of omega-9. Material and methods: a sample of 363 obese subjects was recruited. At the baseline visit the patients were randomly assigned to one of two hypocaloric diets for 12 weeks (diet M, Mediterranean pattern; diet C, standard hypocaloric). All patients, at baseline and at 12 weeks, had biochemical and anthropometric variables measured, and genotyping performed for the rs16147 variant. Results: in all subjects, and with both diets, the parameters of adiposity, blood pressure, and circulating leptin improved. In obese subjects with allele (A) insulin levels (GG vs. GA + AA) (-0.9 ± 1.1 IU/L vs. -4.4 ± 1.0 IU/L; p = 0.01) and HOMA-IR (-0.3 ± 0.1 units vs. -1.2 ± 0.3 units; p = 0.02) decreased significantly with diet M. Subjects carrying the minor allele showed a significant decrease in basal insulin levels (GG vs. GA + AA) (0.7 ± 0.3 IU/L vs. -2.2 ± 0.9 IU/L: p = 0.02) and HOMA-IR (-0.3 ± 0.2 units vs. -0.7 ± 0.1 units: p = 0.01) after diet C. This decrease in circulating insulin and HOMA-IR levels in patients with allele A was significantly higher with diet M than with diet C. Conclusions: the A allele of the rs16147 variant produces a better metabolic response in terms of insulin resistance and basal insulin secondary to weight loss with two different hypocaloric diets in obese subjects, with improvement being higher with the Mediterranean diet.

INTRODUCCIÓN: Introducción y objetivos: los estudios de intervención que evalúan el efecto del rs16147 sobre la respuesta metabólica y el cambio de peso después de una intervención dietética son escasos. Evaluamos el papel de la variante genética rs16147 en los efectos metabólicos que produce una dieta hipocalórica de patrón mediterráneo y alto contenido en omega-9. Material y métodos: se reclutó una muestra de 363 sujetos obesos. En visita basal, los pacientes se asignaron aleatoriamente, durante 12 semanas, a recibir una de dos dietas: dieta M, de patrón mediterráneo, o dieta C, hipocalórica estándar. Se determinaron momento basal y a las 12 semanas, una serie de variables bioquímicas y antropométricas, realizándose el genotipado de la variante rs16147. Resultados: en todos los sujetos con ambas dietas mejoraron los parámetros de adiposidad, tensión arterial y leptina circulante. En sujetos obesos con el alelo menor (A), los niveles de insulina (GG vs. GA + AA) (-0,9 ± 1,1 UI/L vs. -4,4 ± 1,0 UI/L; p = 0,01) y HOMA-IR (-0,3 ± 0,1 unidades vs. -1,2 ± 0,3 unidades; p = 0,02) disminuyeron significativamente con dieta M. Los sujetos portadores del alelo menor tras dieta C mostraron disminución significativa de niveles de insulina basal (GG vs. GA + AA) (0,7 ± 0,3 UI/L vs. -2,2 ± 0,9 UI/L: p = 0,02) y HOMA-IR (-0,3 ± 0,2 unidades vs. -0,7 ± 0,1 unidades: p = 0,01). Esta disminución de los niveles de insulina circulante y HOMA-IR en los pacientes con alelo A fue significativamente superior con la dieta M que con la dieta S. Conclusiones: el alelo A de la variante rs16147 se relaciona con mejor respuesta metabólica, en términos de resistencia a insulina e insulina basal secundaria a pérdida de peso, a dos dietas hipocalóricas, siendo superior el efecto obtenido con una dieta de patrón mediterráneo.

ACYL-CoA synthetase long-chain 5 polymorphism is associated with weight loss and metabolic changes in response to a partial meal-replacement hypocaloric diet.

INTRODUCTION: Aims:to analyze the effects of the rs2419621 genetic variant of the ACSL5 gene on weight change and metabolic parameters after a partial meal-replacement hypocaloric diet. Methods: this was a non-randomized, single-treatment study with a formula-diet in 44 obese subjects with body mass index (BMI) greater than 35 kg/m2. Patients received nutritional education and a modified diet with two intakes of a normocaloric hyperproteic formula during 3 months. Anthropometric parameters and biochemical profile were measured at baseline and after 3 months. The rs2419621 variant of the ACSL5 gene was assessed using real-time polymerase chain reaction. Results: T-allele carriers showed greater improvement in body weight (CC vs. CT + TT; -7.4 ± 2.1 kg vs. -9.3 ± 1.8 kg; p = 0.01), body mass index (-3.1 ± 0.4 kg/m2 vs. -3.4 ± 0.5 kg/m2; p = 0.02), fat mass (-5.2 ± 1.4 kg vs. -6.4 ± 1.2 kg; p = 0.01) and waist circumference (-6.1 ± 1.1 cm vs. -8.6 ± 0.8 cm; p = 0.02) than non-T-allele carriers. Only subjects with the T allele showed significant improvement in triglyceride levels (-4.6 ± 2.4 md/dL vs. -14.4 ± 2.3 mg/dL; p = 0.01). Finally, improvements in insulin (-2.0 ± 0.3 mU/L vs. -4.5 ± 0.5 mU/L; p = 0.01) and HOMA-IR (-0.4 ± 0.2 units vs. -1.3 ± 0.3 units; p = 0.02) were higher in T-allele carriers than in non-T-allele carriers. Conclusions: our data suggest that the genetic variant (rs2419621) of the ACSL5 gene is associated with diet response after a partial-meal replacement intervention, with greater improvements in adiposity and biochemical parameters in subjects with the T allele.

INTRODUCCIÓN: Antecedentes: se hipotetiza que el genotipo de la acil-CoA-sintetasa 5 (ACSL5) podría influir en la pérdida de peso secundaria a la restricción de energía. Objetivos: el objetivo de nuestro estudio fue analizar los efectos de la variante genética rs2419621 del gen ACSL5 sobre el cambio de peso y los parámetros metabólicos después de una dieta hipocalórica parcial de reemplazo. Métodos: estudio no aleatorizado, de centro único, con una fórmula dietética, en 44 sujetos obesos con un índice de masa corporal (IMC) superior a 35 kg/m2. Los pacientes recibieron educación nutricional y una dieta modificada con dos tomas de una fórmula hiperproteica normocalórica durante 3 meses. Los parámetros antropométricos y el perfil bioquímico se determinaron en el tiempo basal y tras 3 meses. La variante rs2419621 del gen ACSL5 se evaluó mediante reacción en cadena de la polimerasa en tiempo real. Resultados: los portadores del alelo T mostraron mejorías de peso corporal (CC vs. CT + TT; -7,4 ± 2,1 kg vs. -9,3 ± 1,8 kg; p = 0,01), índice de masa corporal (-3,1 ± 0,4 kg/m2 vs. -3,4 ± 0,5 kg/m2; p = 0,02), masa grasa (-5,2 ± 1,4 kg vs. -6,4 ± 1,2 kg; p = 0,01) y circunferencia de la cintura (-6,1 ± 1,1 cm vs. -8,6 ± 0,8 cm; p = 0,02) superiores a las de los portadores de alelos distintos de T. Solo los sujetos con alelo T mostraron una mejoría significativa en los niveles de triglicéridos (-4,6 ± 2,4 md/dL vs. -14,4 ± 2,3 mg/dL; p = 0,01). Por último, la mejoría de la insulina (-2,0 ± 0,3 mU/L vs. -4.5 ± 0.5 mU/L; p = 0,01) y HOMA-IR (-0,4 ± 0,2 unidades vs. -1,3 ± 0,3 unidades; p = 0,02) fueron mayores en los portadores de alelos T que en los portadores de alelos no T. Conclusiones: nuestros resultados sugieren que la variante genética (rs2419621) del gen ACSL5 está asociada a la respuesta a la dieta después una dieta hipocalórica parcial de reemplazo, con una mejoría superior de los parámetros relacionados con la adiposidad y los parámetros bioquímicos en los sujetos con alelo T.

Structural Study of the Compounds Formed in the Reactions of FeCl3·6H2O with Ni(OH)2 in the Presence of Dithiolenes HSRSH (R = C6H2Cl2 or C6H4).

In our attempts to prepare coordination polymers by reaction of FeCl3·6H2O and Ni(OH)2 in the presence of dithiolenes HSC6H2X2SH (X = Cl or H), several ion pairs of compounds containing the anionic entity [Ni(SC6H2X2S)2]- were obtained instead. It was also found that other species without dithiolene ligands were formed in these reactions, giving rise to different ion pairs and a tetrametallic cluster. The careful isolation of the different types of crystalline solids allowed the characterization of all of the resulting compounds by single crystal X-ray diffraction (SCXRD). In order to establish the amount of nickel and iron present in the crystals, complementary total reflection X-ray fluorescence (TXRF) analyses were performed. The eight different structural types that were obtained are described and compared with related ones found in the literature.

La variante rs10401670 del gen de la resistina se relaciona con los niveles de resistina circulante, la resistencia a la insulina y la presencia de diabetes mellitus de tipo 2 en los pacientes obesos / The rs10401670 variant of the resistin gene is related to circulating resistin levels, insulin resistance, and presence of type-2 diabetes mellitus in obese patients

INTRODUCCIÓN: el SNP 3'UTR C/T (rs10401670) del gen RETN es un polimorfismo que se ha asociado con la presencia de diabetes mellitus de tipo 2 en un único trabajo en la literatura. OBJETIVO: el objetivo de diseñar este estudio fue evaluar la influencia del SNP rs10401670 del gen de la resistina sobre los niveles séricos de resistina, así como sobre la presencia de diabetes mellitus de tipo 2 en sujetos con obesidad y la resistencia a la insulina. MATERIAL Y MÉTODOS: se analizó una población caucásica de 653 sujetos adultos con obesidad. A todos se les realizó una evaluación antropométrica (peso, circunferencia cintura, masa grasa), una evaluación de la ingesta nutricional y un análisis bioquímico (glucosa, insulina, proteína C-reactiva, perfil lipídico, insulina, HOMA-IR). La evaluación del genotipo rs10401670 se determinó en presencia de diabetes mellitus de tipo 2 (DM2). Se realizó un análisis univariante y posteriormente un análisis de regresión logística con la variable dependiente dicotómica "DM2 = Sí/No" (SPSS, 17.0, IL EUA). RESULTADOS: la distribución del genotipo fue la siguiente: CC, 212 (32,4 %); CT, 340 (52,0 %), y TT, 101 (15,6 %). No se hallaron diferencias significativas entre ambos genotipos en cuanto a perfil lipídico, glucosa basal, proteína C-reactiva, parámetros antropométricos, ingesta nutricional y tensión arterial, pero sí en los niveles de resistina (delta: 1,0 ± 0,2 ng/ml; p = 0,02), insulina (delta: 1,3 ± 0,1 ng/ml; p = 0,02) y HOMA-IR (delta: 1,2 ± 0,2 ng/ml; p = 0,01), que fueron superiores en los pacientes portadores del alelo mutado T. La prevalencia global de la diabetes mellitus de tipo 2 (DM2) en la muestra fue del 21,8 %. Con respecto al SNP rs10401670, entre los sujetos con CC un 17,9 % tenían DM2 y entre los portadores del alelo T, el 23,8 % tenían DM2. En el análisis de regresión logística, al analizar el efecto del alelo T ajustado según la edad, el sexo, los niveles de resistina circulante y el peso corporal, continuó mostrándose como variable independiente la presencia del alelo T del SNP rs10401670 sobre la presencia de DM2: OR: 2,27 (IC 95 %: 1,26-4,09). CONCLUSIONES: el alelo T de la variante genética rs10401670 se asocia con mayores niveles de resistina, insulina basal, resistencia a la insulina y prevalencia de la diabetes mellitus de tipo 2 en los sujetos obesos

BACKGROUND: the SNP 3'UTR C/T (rs10401670) of the RETN gene is a polymorphism that has been associated with the presence of type-2 diabetes mellitus in a single work in the literature. OBJECTIVE: the objective of our study was to evaluate the influence of this resistin gene SNP (rs10401670) on the serum levels of resistin, as well as on the presence of type-2 diabetes mellitus in obese subjects and on insulin resistance. MATERIAL AND METHODS: a Caucasian population of 653 obese subjects was analyzed. All subjects underwent an anthropometric evaluation (weight, waist circumference, fat mass), an evaluation of their nutritional intake, a biochemical profile (glucose, insulin, C-reactive protein, lipid profile, insulin, HOMA-IR), and an assessment of the rs10401670 genotype. Determinations were made in the presence of type-2 diabetes mellitus (DM2). A univariate analysis was carried out and a logistic regression was performed with a dichotomy parameter (DM2: yes/no) (SPSS, 17.0, IL, EUA). RESULTS: genotype distribution was as follows: CC, 212 subjects (32.4 %); CT, 340 subjects (52.0 %); and TT, 101 subjects (15.6 %). There were no significant differences between both genotypes in lipid profile, basal glucose, C-reactive protein, anthropometric parameters, nutritional intake, and blood pressure levels. Serum resistin levels (delta: 1.0 ± 0.2 ng/mL; p = 0.02), insulin levels (delta: 1.3 ± 0.1 ng/mL; p = 0.02), and HOMA-IR (delta: 1.2 ± 0.2 ng/mL; p = 0.01) were higher in T-allele carriers than non-T-allele carriers. The overall prevalence of type-2 diabetes mellitus (DM2) in the sample was 21.8 %. With respect to the rs10401670 polymorphism, 17.9 % of subjects with the CC genotype had DM2, and 23.8 % of T-allele carriers had DM2. In the logistic regression analysis the T-allele of the SNP rs10401670, adjusted by age, sex, resistin levels, and body weight showed an association with DM2 -OR: 2.27 (95 % CI: 1.26-4.09). CONCLUSIONS: the T-allele of the rs10401670 genetic variant is associated with higher levels of resistin, basal insulin, and insulin resistance, and a higher prevalence of type-2 diabetes mellitus, in obese subjects

[The rs10401670 variant of the resistin gene is related to circulating resistin levels, insulin resistance, and presence of type-2 diabetes mellitus in obese patients]. / La variante rs10401670 del gen de la resistina se relaciona con los niveles de resistina circulante, la resistencia a la insulina y la presencia de diabetes mellitus de tipo 2 en los pacientes obesos.

INTRODUCTION: Background: the SNP 3´UTR C/T (rs10401670) of the RETN gene is a polymorphism that has been associated with the presence of type-2 diabetes mellitus in a single work in the literature. Objective: the objective of our study was to evaluate the influence of this resistin gene SNP (rs10401670) on the serum levels of resistin, as well as on the presence of type-2 diabetes mellitus in obese subjects and on insulin resistance. Material and methods: a Caucasian population of 653 obese subjects was analyzed. All subjects underwent an anthropometric evaluation (weight, waist circumference, fat mass), an evaluation of their nutritional intake, a biochemical profile (glucose, insulin, C-reactive protein, lipid profile, insulin, HOMA-IR), and an assessment of the rs10401670 genotype. Determinations were made in the presence of type-2 diabetes mellitus (DM2). A univariate analysis was carried out and a logistic regression was performed with a dichotomy parameter (DM2: yes/no) (SPSS, 17.0, IL, EUA). Results: genotype distribution was as follows: CC, 212 subjects (32.4%); CT, 340 subjects (52.0%); and TT, 101 subjects (15.6%). There were no significant differences between both genotypes in lipid profile, basal glucose, C-reactive protein, anthropometric parameters, nutritional intake, and blood pressure levels. Serum resistin levels (delta: 1.0 ± 0.2 ng/mL; p = 0.02), insulin levels (delta: 1.3 ± 0.1 ng/mL; p = 0.02), and HOMA-IR (delta: 1.2 ± 0.2 ng/mL; p = 0.01) were higher in T-allele carriers than non-T-allele carriers. The overall prevalence of type-2 diabetes mellitus (DM2) in the sample was 21.8%. With respect to the rs10401670 polymorphism, 17.9% of subjects with the CC genotype had DM2, and 23.8% of T-allele carriers had DM2. In the logistic regression analysis the T-allele of the SNP rs10401670, adjusted by age, sex, resistin levels, and body weight showed an association with DM2 - OR: 2.27 (95% CI: 1.26-4.09). Conclusions: the T-allele of the rs10401670 genetic variant is associated with higher levels of resistin, basal insulin, and insulin resistance, and a higher prevalence of type-2 diabetes mellitus, in obese subjects.

INTRODUCCIÓN: Introducción: el SNP 3´UTR C/T (rs10401670) del gen RETN es un polimorfismo que se ha asociado con la presencia de diabetes mellitus de tipo 2 en un único trabajo en la literatura. Objetivo: el objetivo de diseñar este estudio fue evaluar la influencia del SNP rs10401670 del gen de la resistina sobre los niveles séricos de resistina, así como sobre la presencia de diabetes mellitus de tipo 2 en sujetos con obesidad y la resistencia a la insulina. Material y métodos: se analizó una población caucásica de 653 sujetos adultos con obesidad. A todos se les realizó una evaluación antropométrica (peso, circunferencia cintura, masa grasa), una evaluación de la ingesta nutricional y un análisis bioquímico (glucosa, insulina, proteína C-reactiva, perfil lipídico, insulina, HOMA-IR). La evaluación del genotipo rs10401670 se determinó en presencia de diabetes mellitus de tipo 2 (DM2). Se realizó un análisis univariante y posteriormente un análisis de regresión logística con la variable dependiente dicotómica "DM2 = Sí/No" (SPSS, 17.0, IL EUA). Resultados: la distribución del genotipo fue la siguiente: CC, 212 (32,4%); CT, 340 (52,0%), y TT, 101 (15,6%). No se hallaron diferencias significativas entre ambos genotipos en cuanto a perfil lipídico, glucosa basal, proteína C-reactiva, parámetros antropométricos, ingesta nutricional y tensión arterial, pero sí en los niveles de resistina (delta: 1,0 ± 0,2 ng/ml; p = 0,02), insulina (delta: 1,3 ± 0,1 ng/ml; p = 0,02) y HOMA-IR (delta: 1,2 ± 0,2 ng/ml; p = 0,01), que fueron superiores en los pacientes portadores del alelo mutado T. La prevalencia global de la diabetes mellitus de tipo 2 (DM2) en la muestra fue del 21,8%. Con respecto al SNP rs10401670, entre los sujetos con CC un 17,9% tenían DM2 y entre los portadores del alelo T, el 23,8% tenían DM2. En el análisis de regresión logística, al analizar el efecto del alelo T ajustado según la edad, el sexo, los niveles de resistina circulante y el peso corporal, continuó mostrándose como variable independiente la presencia del alelo T del SNP rs10401670 sobre la presencia de DM2: OR: 2,27 (IC 95%: 1,26-4,09). Conclusiones: el alelo T de la variante genética rs10401670 se asocia con mayores niveles de resistina, insulina basal, resistencia a la insulina y prevalencia de la diabetes mellitus de tipo 2 en los sujetos obesos.

Kinesio taping versus compression garments for treating breast cancer-related lymphedema: a randomized, cross-over, controlled trial.

OBJECTIVE: To determine the effectiveness of Kinesio taping compared to compression garments during maintenance phase of complex decongestive therapy for breast cancer-related lymphedema. DESIGN: Randomized, cross-over, controlled trial. SETTING: Outpatient tertiary-level hospital rehabilitation setting. SUBJECTS: Randomized sample of 30 women with breast cancer-related lymphedema. INTERVENTIONS: Participants received two interventions, Kinesio taping and compression garment, both lasting four weeks, whose order was randomized by blocks. A four-week washout period was established prior to the interventions and between them. MEASUREMENTS: The main outcome was the lymphedema Relative Volume Change. Secondary outcomes were range of motion of arm joints, self-perception of comfort, and lymphedema-related symptoms (pain, tightness, heaviness, and hardness). RESULTS: The decrease in the Relative Volume Change was greater in the Kinesio taping intervention (-5.7%, SD = 2.0) compared to that observed using compression garments (-3.4%, SD = 2.9) (P < 0.001). The range of motion of five upper-limb movements increased after applying taping (between 5.8° and 16.7°) (P < 0.05), but not after compression (P > 0.05). In addition, taping was perceived as more comfortable by patients (between 2.4 and 3 points better than compression in four questions with a 5-point scale (P < 0.001)) and further reduced lymphedema-related symptoms compared to compression (between 0.96 and 1.40 points better in four questions with a 6-point scale (P < 0.05)). CONCLUSION: Kinesio taping was more effective than compression garments for reducing the lymphedema volume, with less severe lymphedema-related symptoms, better improvement of upper-limb mobility, and more comfort.