Menor síndrome adyacente superior y menor tasa de reoperación. Resultados a mediano y largo plazo de la artroplastia cervical frente a la artrodesis cervical anterior: revisión sistemática y metaanálisis de ensayos clínicos aleatorizados / Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials

Objetivo: Comparar a mediano y largo plazo los resultados quirúrgicos postoperatorios, sobre todo la tasa del síndrome adyacente, tasa de eventos adversos y tasa de reoperación, de los pacientes operados con artroplastia cervical o artrodesis cervical anterior en los ensayos clínicos aleatorizados (ECA) publicados de un nivel cervical. Métodos: Revisión sistemática y metaanálisis. Se seleccionaron 13 ECA. Se analizaron los resultados clínicos, radiológicos y quirúrgicos, tomando como variables primarias la tasa del síndrome adyacente, tasa de eventos adversos y tasa de reoperación. Resultados: Fueron 2.963 los pacientes analizados. El grupo de artroplastia cervical mostró una menor tasa de síndrome adyacente superior (p<0,001), menor tasa de reoperación (p<0,001), menor dolor radicular (p=0,002) y una mejor puntuación en el índice de discapacidad cervical (p=0,02) y en el componente físico SF-36 (p=0,01). No se encontraron diferencias significativas en la tasa del síndrome adyacente inferior, tasa de eventos adversos, dolor cervical ni componente mental SF-36. Se halló en la artroplastia cervical un rango de movilidad medio de 7,91 grados en el seguimiento final y una tasa de osificación heterotópica de 9,67%. Conclusión: En el seguimiento a mediano y largo plazo, la artroplastia cervical mostró menor tasa de síndrome adyacente superior y menor tasa de reintervención. No se hallaron diferencias estadísticamente significativas en la tasa del síndrome adyacente inferior ni en la tasa de eventos adversos.(AU)

Objective: To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. Methods: Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. Results: Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91 degrees was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. Conclusion: In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.(AU)

[Translated article] Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials / Menor síndrome adyacente superior y menor tasa de reoperación. Resultados a mediano y a largo plazo de la artroplastia cervical frente a la artrodesis cervical anterior: revisión sistemática y metaanálisis de ensayos clínicos aleatorizados

Objetivo: Comparar a mediano y largo plazo los resultados quirúrgicos postoperatorios, sobre todo la tasa del síndrome adyacente, tasa de eventos adversos y tasa de reoperación, de los pacientes operados con artroplastia cervical o artrodesis cervical anterior en los ensayos clínicos aleatorizados (ECA) publicados de un nivel cervical. Métodos: Revisión sistemática y metaanálisis. Se seleccionaron 13 ECA. Se analizaron los resultados clínicos, radiológicos y quirúrgicos, tomando como variables primarias la tasa del síndrome adyacente, tasa de eventos adversos y tasa de reoperación. Resultados: Fueron 2.963 los pacientes analizados. El grupo de artroplastia cervical mostró una menor tasa de síndrome adyacente superior (p<0,001), menor tasa de reoperación (p<0,001), menor dolor radicular (p=0,002) y una mejor puntuación en el índice de discapacidad cervical (p=0,02) y en el componente físico SF-36 (p=0,01). No se encontraron diferencias significativas en la tasa del síndrome adyacente inferior, tasa de eventos adversos, dolor cervical ni componente mental SF-36. Se halló en la artroplastia cervical un rango de movilidad medio de 7,91 grados en el seguimiento final y una tasa de osificación heterotópica de 9,67%. Conclusión: En el seguimiento a mediano y largo plazo, la artroplastia cervical mostró menor tasa de síndrome adyacente superior y menor tasa de reintervención. No se hallaron diferencias estadísticamente significativas en la tasa del síndrome adyacente inferior ni en la tasa de eventos adversos.(AU)

Objective: To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. Methods: Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. Results: Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91 degrees was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. Conclusion: In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.(AU)

Bacterial lipopolysaccharide forms aggregates with apolipoproteins in male and female rat brains after ethanol binges.

Alcohol binge drinking allows the translocation of bacterial lipopolysaccharide (LPS) from the gut to the blood, which activates the peripheral immune system with consequences in neuroinflammation. A possible access/direct signaling of LPS to/in the brain has not yet been described under alcohol abuse conditions. Apolipoproteins are compounds altered by alcohol with high affinity to LPS which may be involved in its transport to the brain or in its elimination. Here, we explored the expression of small components of LPS, in its free form or bound to apolipoproteins, in the brain of female and male rats exposed to alcohol binges. Animals received ethanol oral gavages (3 g/kg every 8 h) for 4 days. LPS or its components (Lipid A and core), LPS-binding protein, corticosterone, lipoproteins (HDL, LDL), apolipoproteins (ApoAI, ApoB, and ApoE), and their receptors were measured in plasma and/or in nonperfused prefrontal cortex (PFC) and cerebellum. Brain LipidA-apolipoprotein aggregates were determined by Western blotting and confirmed by co-immunoprecipitation. In animals exposed to alcohol binges: 1) plasma LPS-binding protein was elevated in both sexes; 2) females showed elevations in plasma ApoAI and corticosterone levels; 3) Lipid A formed aggregates with ApoAI in the female PFC and with ApoB in males, the latter showing Toll-like receptor 4 upregulation in PFC but not females. These results suggest that small bacterial components are present within the brain, forming aggregates with different apolipoproteins, depending on the sex, after alcohol binge intoxications. Results may have implications for the crosstalk between alcohol, LPS, and neuroinflammation.

[Translated article] Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials.

OBJECTIVE: To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. METHODS: Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. RESULTS: Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91° was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. CONCLUSION: In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.

Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials. / Menor síndrome adyacente superior y menor tasa de reoperación. Resultados a mediano y largo plazo de la artroplastia cervical frente a la artrodesis cervical anterior: revisión sistemática y metaanálisis de ensayos clínicos aleatorizados.

OBJECTIVE: To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. METHODS: Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. RESULTS: Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91 degrees was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. CONCLUSION: In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.

Impacto del confinamiento en el patrón epidemiológico del traumatismo pediátrico / Impact of confinement on the epidemiologic pattern of pediatric trauma

Introducción: El trauma es unas de las causas principales de morbilidad y mortalidad en la infancia. El aislamiento de la población durante la pandemia de 2020 provocó cambios en la frecuencia y gravedad de los traumatismos pediátricos, debido a las modificaciones y restricciones en la dinámica social, el miedo al contagio y la reorganización de la atención sanitaria. Objetivos. Analizar el efecto que tiene el confinamiento de la población infantil en los patrones epidemiológicos y la asistencia sanitaria de urgencias a los traumatismos pediátricos, tomando como referencia un hospital de tercer nivel. Material y métodos. Estudio retrospectivo, comparativo y descriptivo. Análisis de los pacientes atendidos por traumatismo a cualquier nivel en el Servicio de Urgencias de un hospital de tercer nivel, durante los primeros quince días de confinamiento (marzo 2020), comparándolo con el mismo periodo prepandemia. Resultados. Del total de 388 pacientes, 40 fueron atendidos durante el confinamiento (88,5% menos que el mismo periodo del año anterior). La media de edad del grupo prepandemia fue significativamente superior. La gravedad, medida con el Índice de Trauma Pediátrico (ITP), fue mayor en pacientes del grupo confinamiento. El lugar más frecuente de lesión durante la pandemia fue en el domicilio, con un aumento de lesiones de localización facial. Conclusiones. Durante el aislamiento poblacional en la pandemia por SARS-CoV-2 se produjo una disminución en la demanda de la atención de traumas pediátricos en Urgencias, objetivándose un aumento en la gravedad de los niños atendidos. El confinamiento de la población produjo cambios en los patrones de lesión, así como en la localización de las lesiones más frecuentes.(AU)

Introduction: Trauma is among the leading causes of morbidity and mortality in childhood. The isolation of the population during the 2020 pandemic caused changes in the frequency and severity of pediatric trauma, due to modifications and restrictions in social dynamics, fear of contagion and reorganization of health care. Objectives. To analyze the impact of the confinement of the pediatric population on epidemiological patterns and emergency health care for pediatric trauma, taking a tertiary level hospital as a reference. Material and methods. Retrospective, comparative and descriptive study. Analysis of patients treated for trauma at any level in the Emergency Department of a tertiary hospital, during the first fifteen days of confinement (March 2020), compared with the same pre-pandemic period. Results. Of the total of 388 patients, 40 were seen during confinement (88.5% less than the same period of the previous year). The mean age of the pre-pandemic group was significantly higher. The severity in patients in the confinement group was higher than in pre-pandemic patients. The most frequent site of injury during confinement was at home, with an increase in facial injuries. Conclusions. During the SARS-CoV-2 pandemic, there was a decrease in the demand for pediatric trauma emergency care, with an increase in the severity of the children seen. There were changes in injury patterns, as well as in the location of the most frequent lesions.(AU)

Hemorragia alveolar pulmonar como presentación poco frecuente de infección por Leptospira spp: una enfermedad ocupacional del personal militar en zonas tropicales / Pulmonary alveolar hemorrhage as an unusual presentation of Leptospira spp: an occupational-disease of military personnel in tropical zones

Resumen La leptospirosis es una de las zoonosis endémicas más importantes en el mundo con un aumento de la incidencia en los últimos años. En el personal militar podría ser catalogada como una enfermedad ocupacional dado sus actividades específicas en áreas rurales. Su presentación clínica es variable siendo en la mayoría de los casos una enfermedad febril autolimitada. De acuerdo con diversos factores dependientes del patógeno y del hospedero pueden presentarse manifestaciones severas de la enfermedad dentro de la cual destaca el compromiso pulmonar con una alta tasa de mortalidad. Existe evidencia del uso de esteroide sistémico como parte del tratamiento de esta complicación. Presentamos el caso de un paciente joven, militar, que debuta con síndrome de hemorragia alveolar difusa secundario a leptospirosis y presenta una excelente respuesta al tratamiento con altas dosis de metilprednisolona, con una discusión del proceso diagnóstico y aspectos fisiopatológicos de esta condición.

Leptospirosis is one of the most important endemic zoonoses in the world with an increase in incidence in recent years. In military personnel it could be classified as an occupational disease given their specific activities in rural areas. Its clinical presentation is variable being in most cases a self-limited febrile disease. According to various factors dependent on the pathogen and the host, severe manifestations of the disease may occur within which the pulmonary involvement with a high mortality rate stands out. There is evidence of systemic steroid use as part of the treatment of this complication. We present a case of a young, military patient who debuts with diffuse alveolar hemorrhage syndrome secondary to leptospirosis and presents an excellent response to treatment with high doses of methylprednisolone, with a discussion of the diagnostic process and pathophysiological aspects of this condition.

Fortalezas y dificultades para el ajuste emocional en niños aymara desde la perspectiva de los menores, padres y profesores / Strengths and difficulties in emotional adjustment of Aymara children from the perspective of children, parents and teachers

Objective: To describe capabilities and difficulties in emotional adjustment experienced by children living in the Chilean Aymara city of Arica. Patients and Method: 610 students between 5th and 8th grade, in addition to their parents and teachers were surveyed using the Strengths and Difficulties Questionnaire (SDQ), comparing Aymara children to those without indigenous heritage. 25 items divided into five scales were evaluated: Emotional, behavioral problems, hyperactivity, relationship problems with peers and prosocial behaviors, classifying the respondents into three levels, Normal, Border and Abnormal. Results: There were no significant differences among the groups studied, where discrepancies in almost all cases show a slight effect (d ≥ -0.2-). Also, no relevant effects were observed regarding the type of assessor on the assessment of each dimension. Despite this, it was observed that Aymara children showed lower scores than their peers in "behavioral problems" according to their teachers, but this difference was also mild (partial η2> 0.01). Conclusions: Aymara Children showed similar strengths and difficulties than non-Aymara students in situations that require emotional adjustment.

Objetivo: Describir capacidades y dificultades en el ajuste emocional experimentadas por niños aymara residentes en la ciudad chilena de Arica. Pacientes y M étodo: Se encuestó a 610 alumnos de 5° a 8° año de Enseñanza General Básica de la ciudad de Arica, además de sus padres y profesores, mediante el Cuestionario de Capacidades y Dificultades (SDQ), comparando a niños aymara con aquellos sin ascendencia indígena. Se evaluaron 25 ítems divididos en 5 escalas: emocional, problemas de comportamiento, hiperactividad, problemas de relación con pares y conductas prosociales, clasificando a los encuestados en tres niveles, Normal, Límite o Anormal. Resultados: No hubo diferencias poblacionales relevantes en las dimensiones del SDQ entre grupos estudiados, donde las discrepancias en prácticamente todos los casos muestran un efecto leve (d ≥ -0,2-). Tampoco se observaron efectos poblacionales relevantes respecto del tipo de evaluador sobre la valoración de cada dimensión. Pese a esto, cabe señalar que niños aymara mostraron una menor puntuación que sus pares en "problemas de comportamiento" según sus profesores, pero dicha interacción poblacional también fue leve (η² parcial > 0,01). Conclusiones: Niños aymara mostraron fortalezas y dificultades similares a las de sus pares no aymara ante situaciones que requieren ajuste emocional.

EMG- biofeedback en el tratamiento de la incontinencia urinaria y calidad de vida / Electromiography-biofeedback in the treatment of urinary incontinence and quality of life

Introducción: La incontinencia urinaria se define como la manifestación de cualquier escape involuntario de orina. Se clasifica clínicamente en incontinencia de esfuerzo, urgencia y mixta. Enfermedad infradiagnosticada con importante impacto social, económico y psicológico. Afecta a ambos sexos, deteriorando la calidad de vida de los que la padecen. Material y métodos: La muestra se compone de 310 pacientes, varones y mujeres con distintos tipos de incontinencia urinaria. Todos fueron tratados con 20 sesiones de electromiografía-biofeedback con electrodos de superficie colocados alrededor del ano a las 3 y 9 h, realizadas bisemanalmente y evaluados con los cuestionarios/escalas ICIQ-SF y I -QOL específicos de calidad de vida en la incontinencia urinaria. Resultados: La edad media fue de 57,3 ± 15,19 años. Las mujeres fueron el 83,6% y los varones el 16,4%. Se ha encontrado significación estadística (p < 0,05) entre incontinencia urinaria y antecedentes de embarazo, parto, menopausia y cirugía ginecológica en mujeres. Cirugía urológica y abdominal en ambos sexos y prostatectomía radical en varones. El tipo más frecuente fue el de esfuerzo en ambos sexos. Tras el tratamiento con electromiografía-biofeedback se objetiva una variación de mejoría del valor de las medianas con significación estadística para los 2 cuestionarios/escalas empleados, tanto en la muestra total de incontinentes, como para los distintos tipos de incontinencia y subescalas del cuestionario I -QOL. Conclusión: Dado los resultados hallados en nuestro estudio y la bibliografía, concluimos que la electromiografía-biofeedback para el entrenamiento de la musculatura del suelo pélvico en la incontinencia urinaria mejora la incontinencia y la calidad de vida (AU)

Introduction: Urinary incontinence (UI) is defined as any involuntary loss of urine. Clinically, it is classified into three categories: stress, urgency and mixed incontinence. The diagnosis of UI is underdiagnosed, this having an economic, social and psychological impact. It affects both male and female, with deterioration in their quality of life (QOL).Material and methods: The sample was made up of 310 patients, male and female, with different types of UI. They were all treated with 20 sessions of electromiography-biofeedback, twice a week. Superficial electrodes were used around the anus, at 3 and 9 o’clock hours, and self administered ICIQ-SF and I-QOL questionnaires/scales were used. Results: Mean age was 57.3±15.19 years. There were 83.6% female and 16.4% male. A statistically significant (P<0.05) difference was found between UI and background of pregnancy, delivery, menopause and gynecological surgery in women; abdominal and urogynecological surgery in both sexes; and radical prostatectomy in males. The most frequent IU type was effort in both sexes. After electromiography-biofeedback treatment, we have found a statistically significant improvement (P<0.05) in the mean values for both of the questionnaire/scales used, in the UI sample of incontinent patients and for the different UI types, as well as in the different I-QOL subscales. Conclusion: After analyzing our data and the literature reviewed, we have concluded that electromyography-biofeedback is effective as a training technique of the pelvic floor muscles in urinary incontinence and in improving the quality of life of such patients (AU)

Escápula alada, ¿una entidad del área quirúrgica? / Winged scapula, a condition for the surgical area?

La escápula alada secundaria a la lesión del nervio torácico largo es una entidad poco frecuente. La etiología más frecuente relatada en la bibliografía está relacionada con actividades en el área quirúrgica, ya sea por malposicionamiento durante la anestesia-cirugía, ya sea por un evento traumático iatrogénico durante los procedimientos quirúrgicos. Exponemos 3 casos clínicos junto con una breve revisión etiológica y bibliográfica, para revisar las múltiples etiologías de dicha lesión y así no atribuirla siempre a dicha área de actuación, ya que estos no son los únicos causantes de la misma (AU)

The winged scapula secondary to long thoracic nerve injury is an uncommon condition. It is most frequently reported in the literature associated with surgical activities, either due to poor positioning during anesthesia or by an iatrogenic traumatic event during surgical procedures. We expose 3 cases and a brief etiological and literature review, to present the multiple origins of this injury, which are not always related to this area of activity, as these are not the only causes of this injury (AU)

[Winged scapula, a condition for the surgical area?]. / Escápula alada, ¿una entidad del área quirúrgica?

The winged scapula secondary to long thoracic nerve injury is an uncommon condition. It is most frequently reported in the literature associated with surgical activities, either due to poor positioning during anesthesia or by an iatrogenic traumatic event during surgical procedures. We expose 3 cases and a brief etiological and literature review, to present the multiple origins of this injury, which are not always related to this area of activity, as these are not the only causes of this injury.

Persistence and transferability of noroviruses on and between common surfaces and foods.

Human noroviruses (HuNoV) are the leading cause of foodborne disease, and poor personal hygiene practices of infected workers are the most common mode of contamination. The purpose of this study was to characterize the persistence and transferability of representative noroviruses Norwalk virus (NV), Snow Mountain virus (SMV), and murine norovirus 1 (MNV-1) on and between solid surfaces and foods. Changes in virus concentration on artificially inoculated solid surfaces (stainless steel, ceramic, and Formica) or lettuce were monitored over a period of 14 to 42 days. Virus transfer was evaluated from donor (solid surface) to recipient (food, e.g., lettuce and sliced turkey deli meat) for up to 2 h postinoculation. Viruses were recovered by elution and titered with reverse transcription quantitative PCR (RT-qPCR) and/or infectivity assay, as appropriate. Based on RTqPCR, the concentration of NV and SMV on surfaces dropped gradually over time, with an average reduction of 1.5 to 2.0 and 1.8 to 2.3 log, respectively, after 42 days, with no statistically significant differences by surface. When inoculated onto lettuce stored for 2 weeks at 4°C and room temperature, the titers of NV and SMV dropped by approximately 1.0 and 1.2 to 1.8 log, respectively. Comparatively, the RT-qPCR signal associated with purified HuNoV RNA placed on the same surfaces was more rapidly lost to degradation. Transfer efficiency ranged from 0 to 26 % for lettuce and from 55 to 95 % for sliced turkey deli meat, with statistically significant differences (P ≤ 0.05) in transferability as a function of contact pressure (100 and 1,000 g/9 cm(2)) and inoculum drying time. When similar experiments were done with MNV-1, infectious virus failed to be detected on solid surfaces after storage day 21, although the virus did persist on lettuce. This study provides much needed quantitative data for use in risk assessment efforts intended to characterize the transmission of HuNoV during food preparation and handling.

Can the clinical outcome in stage II colon carcinomas be predicted by determination of molecular marker expression?

BACKGROUND: Conventional staging procedures are often unable to precisely predict prognosis in colon cancer (CC). In this study, we set out to investigate the possible role of molecular/structural indicators involved in cell cycle regulation (Ki-67, p53), apoptosis (p53 and bcl-2) and tumour neoangiogenesis (anti-VIII factor) in predicting tumour behaviour and clinical outcome in stage II CC patients. EXPERIMENTAL DESIGN: Analysis of the above indicators was performed by immunohistochemistry on 162 CC patient samples with curative intention surgery. Clinicopathological data included tumour grade, vascular and nervous invasion, production of mucin, lymphatic permeation and carcinoembryonic antigen levels. RESULTS: p53 protein was overexpressed in 58%, bcl-2 overexpression in 21.5%, Ki-67 in 60.1% and anti-VIII factor stained positive in 40.16% of the cases. Multiple regression analysis showed that some molecular markers were correlated. A significant relationship was seen between p53 and Ki-67, and bcl-2 and p53, but there was no correlation between bcl2 and Ki- 67 overexpression. Stepwise regression selected Ki-67 and anti-VIII factor as the best combination of variables capable of predicting both disease-specific and diseasefree survival. CONCLUSIONS: Only Ki-67 and anti-VIII factor were shown to be useful for the prediction of outcome and recurrence rate in curatively treated CC patients. In conjunction with clinical and pathological staging, they may provide a stronger indication of clinical outcome than staging alone and help better select therapeutic options in CC patients.

Can the clinical outcome in stage II colon carcinomas be predicted by determination of molecular marker expression?

BACKGROUND: Conventional staging procedures are often unable to precisely predict prognosis in colon cancer (CC). In this study, we set out to investigate the possible role of molecular/structural indicators involved in cell cycle regulation (Ki-67, p53), apoptosis (p53 and bcl-2) and tumour neoangiogenesis (anti-VIII factor) in predicting tumour behaviour and clinical outcome in stage II CC patients. EXPERIMENTAL DESIGN: Analysis of the above indicators was performed by immunohistochemistry on 162 CC patient samples with curative intention surgery. Clinicopathological data included tumour grade, vascular and nervous invasion, production of mucin, lymphatic permeation and carcinoembryonic antigen levels. RESULTS: p53 protein was overexpressed in 58%, bcl-2 overexpression in 21.5%, Ki-67 in 60.1% and anti-VIII factor stained positive in 40.16% of the cases. Multiple regression analysis showed that some molecular markers were correlated. A significant relationship was seen between p53 and Ki-67, and bcl-2 and p53, but there was no correlation between bcl2 and Ki- 67 overexpression. Stepwise regression selected Ki-67 and anti-VIII factor as the best combination of variables capable of predicting both disease-specific and diseasefree survival. CONCLUSIONS: Only Ki-67 and anti-VIII factor were shown to be useful for the prediction of outcome and recurrence rate in curatively treated CC patients. In conjunction with clinical and pathological staging, they may provide a stronger indication of clinical outcome than staging alone and help better select therapeutic options in CC patients (AU)

Malrotación intestinal en adulto y apendicitis aguda / Intestinal malrotation in adults and acute appendicitis

No disponible

Hepatocarcinoma: alternativas terapéuticas / Hepatocarcinoma: therapeutic alternatives

Esta patología poco común es causa de 1 millón de muertes al año con un pronóstico vital a 5 años de 5.7 por ciento. El marcador biológico más útil para su diagnóstico es la elevación de la Alfa Feto Proteína (AFP) además de servir como un marcador pronóstico. para determinar los pacientes candidatos a procedimientos quirúrgicos, así como la severidad de la enfermedad se utiliza la clasificación de child´s-Pugh y la de Okuda. El tratamiento se basa principalmente en el acto quirúrgico en aquellos pacientes que tienen la enfermedad localizada y en quimioterapia sistémica inmunoterapia, embolización o ligadura de la arteria hepática, inyección percutánea de etanol, ablación con radiofrecuencia, crioterapia y anticuerpos marcados...

[First non-autologous vascular access for hemodialysis: PTFE fistula]. / Primer acceso vascular no autólogo para hemodiálisis. Prótesis de PTFE humero-antecubital curva de antebrazo.

INTRODUCTION: Since 1999 to 2003 we have tried to perform an antebraquial "loop" PTFE fistula (PTFEa) as first vascular access for hemodialysis in patients without suitable superficial venous system. MATERIAL AND METHODS: We have performed a prospective study to analyze the results (permeability and complications) with this approach. RESULTS: We could perform 44 PTFEa in 46 consecutive patients (in two cases we used the axillary vein as return vessel). Early failure was 0%. One year primary and secondary permeability were 66% and 90% respectively. CONCLUSIONS: PTFEa is a good solution as first vascular access in patients without a suitable superficil venous system.

Humanismo y tecnología en los cuidados de enfermería desde la perspectiva docente / Humanism and technology in nursing care from the teaching perspective

Una de las características de nuestra época es el gran desarrollo tecnológico en particular en las ciencias de la salud y de la vida. Este hecho, sumado a la hegemonía de ciertos valores de nuestra sociedad, ha propiciado la pérdida de la visión central del hombre en los procesos asistenciales, llegando en ocasiones a situaciones de deshumanización que vulneran la dignidad de las personas. En el ámbito asistencial, a menudo la tecnología y el humanismo se presentan como elementos contrapuestos o incluso excluyentes, cuando en realidad lo que sucede es que ambos son complementarios en la asistencia sanitaria en general y en particular en los cuidados de enfermería. Los datos de algunas encuestas y estudios sobre las expectativas y demandas de los ciudadanos al sistema sanitario nos informan de que las personas quieren que, cuando lo precisen, se les aplique la mejor tecnología existente pero al mismo tiempo con el mayor humanismo posible, es decir que se les aplique la tecnología sin olvidar que la persona es el verdadero centro de la atención de los cuidados, lo que implica que deben ser informados (..) (AU)

One of the characteristics of our age is the huge development of technology, particularly in the health and life sciences. This development, together with the hegemony of certain values in our society, has encouraged the loss of a humane central vision in health care processes, sometimes leading to dehumanizing situations putting human dignity at risk In the healthcare setting, technology and humanism are sometimes presented as conflicting, or even as mutually exclusive, when in fact they are complementary elements of healthcare in general and of nursing care in particular. Data from various surveys and studies of users’ expectations and demands of the healthcare system reveal that, when necessary, users wish tounder go the most advanced technology available but, at the same time, to be treated with the greatest possible humanism, that is, patients want (..) (AU)

TSH stimulates leptin secretion by a direct effect on adipocytes.

Leptin is a circulating hormone secreted by adipose tIssue which acts as a signal to the central nervous system where it regulates energy homeostasis and neuroendocrine processes. Although leptin modulates the secretion of several pituitary hormones, no information is available regarding a direct action of pituitary products on leptin release. However, it has been pointed out that leptin and TSH have a coordinated pulsatility in plasma. In order to test a direct action of TSH on in vitro leptin secretion, a systematic study of organ cultures of human omental adipose tIssue was performed in samples obtained at surgery from 34 patients of both sexes during elective abdominal surgery. TSH powerfully stimulated leptin secretion by human adipose tIssue in vitro. In contrast, prolactin, ACTH, FSH and LH were devoid of action. These results suggest that leptin and the thyroid axis maintain a complex and dual relationship and open the possibility that plasmatic changes in TSH may contribute to the regulation of leptin pulses.