The Relation of CFTR-Genotype and Associated Comorbidities to Development of Pulmonary Atelectasis in Cystic Fibrosis Patients

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Use of CT-scan in pediatric patients with thoraco-abdominal trauma: experience at a latin-american trauma facility. / Uso de la TAC en pacientes pediátricos con trauma toraco-abdominal: experiencia de un centro de trauma latinoamericano.

INTRODUCTION: CT-scan is the method of choice for major trauma assessment. However, it significantly increases radiation exposure in the pediatric population. The objective of this study was to analyze differences in clinical outcomes according to the preoperative use of CT-scan. MATERIALS AND METHODS: A retrospective observational study of pediatric patients admitted for trauma and requiring surgery was carried out. Patients were classified according to the previous use of CT-scan. ICU stay, re-admissions, and deaths were assessed. RESULTS: From 2011 to 2017, 737 patients under 18 years of age with external lesions were treated, 174 of whom required surgery. 48 patients (27.6%) underwent CT-scan prior to the procedure (Group 1), while the remaining 126 patients (72.4%) were directly scheduled for surgery (Group 2). Penetrating trauma occurred in 81% of patients, the proportion being significantly higher in Group 2 (p= 0.001). Median age was 15 years (interquartile range: 12-17), with no differences between groups. No significant differences were found in terms of hemodynamic instability at admission between groups (p= 0.596). At surgery, 3 out of 48 patients (6.3%) had no evident lesion. No significant differences were found in terms of re-admissions (p= 0.476), mortality (0.994), and ICU stay (0.466). CONCLUSION: The use of CT-scan as a diagnostic tool in pediatric trauma does not reduce mortality, ICU stay, or number of re-admissions. The use of tools such as ultrasound examination and simple X-ray should be protocolized to avoid unnecessary exposure to higher radiation doses. Prospective studies confirming this hypothesis are required.

INTRODUCCION: La tomografía axial computarizada (TAC) es el método de elección en la evaluación del trauma mayor, sin embargo, aumenta significativamente la exposición a radiación en la población pediátrica. El objetivo de este estudio es determinar diferencias en los desenlaces clínicos de acuerdo con el uso preoperatorio de la TAC. METODOS: Estudio observacional retrospectivo. Se incluyeron pacientes pediátricos ingresados por trauma que necesitaron manejo quirúrgico, y se clasificaron de acuerdo con el uso previo de TAC. Se evaluó tiempo en Unidad de Cuidados Intensivos (UCI), readmisiones, y muerte. RESULTADOS: Durante 2011 a 2017, 737 pacientes menores de 18 años consultaron por lesiones de causa externa, 174 requirieron intervención quirúrgica. A 48 (27,6%) se les realizó TAC previo al manejo quirúrgico (Grupo 1); los restantes 126 pacientes (72,4%) fueron llevados directamente a cirugía (Grupo 2). El trauma penetrante se presentó en un 81% de los pacientes, siendo significativamente mayor en el grupo 2 (p= 0,001). La mediana de edad fue 15 años (rango intercuartílico 12-17) sin diferencia entre los grupos. No hubo diferencias significativas en inestabilidad hemodinámica al ingreso entre los grupos (p= 0,596). Al momento de la cirugía, tres de 48 pacientes (6,3%) no presentaron ninguna lesión evidente. No hubo diferencias significativas en las readmisiones (p= 0,476), la mortalidad (0.994) y estancia en UCI (0,466). CONCLUSION: El uso de TAC como herramienta diagnóstica en trauma pediátrico no disminuye la mortalidad, días de estancia en UCI, ni el número de readmisiones. Debe protocolizarse el uso de herramientas como la ecografía y radiografía simple para evitar exposición innecesaria a dosis más altas de radiación. Se requieren estudios prospectivos que confirmen esta hipótesis.

Uso de la TAC en pacientes pediátricos con trauma toraco-abdominal: experiencia de un centro de trauma latinoamericano / Use of CT-scan in pediatric patients with thoraco- abdominal trauma: experience at a latin-american trauma facility

Introducción: La tomografía axial computarizada (TAC) es el método de elección en la evaluación del trauma mayor, sin embargo, aumentasignificativamente la exposición a radiación en la población pediátrica.El objetivo de este estudio es determinar diferencias en los desenlacesclínicos de acuerdo con el uso preoperatorio de la TAC. Métodos: Estudio observacional retrospectivo. Se incluyeron pacientes pediátricos ingresados por trauma que necesitaron manejo quirúrgico, y se clasificaron de acuerdo con el uso previo de TAC. Se evaluótiempo en Unidad de Cuidados Intensivos (UCI), readmisiones, y muerte.Resultados: Durante 2011 a 2017, 737 pacientes menores de 18años consultaron por lesiones de causa externa, 174 requirieron intervención quirúrgica. A 48 (27,6%) se les realizó TAC previo al manejoquirúrgico (Grupo 1); los restantes 126 pacientes (72,4%) fueron llevadosdirectamente a cirugía (Grupo 2). El trauma penetrante se presentó enun 81% de los pacientes, siendo significativamente mayor en el grupo2 (p= 0,001). La mediana de edad fue 15 años (rango intercuartílico 12-17) sin diferencia entre los grupos. No hubo diferencias significativasen inestabilidad hemodinámica al ingreso entre los grupos (p= 0,596).Al momento de la cirugía, tres de 48 pacientes (6,3%) no presentaronninguna lesión evidente. No hubo diferencias significativas en las read-misiones (p= 0,476), la mortalidad (0,994) y estancia en UCI (0,466). Conclusión: El uso de TAC como herramienta diagnóstica en trau-ma pediátrico no disminuye la mortalidad, días de estancia en UCI, niel número de readmisiones. Debe protocolizarse el uso de herramientascomo la ecografía y radiografía simple para evitar exposición innecesariaa dosis más altas de radiación. Se requieren estudios prospectivos queconfirmen esta hipótesis.(AU)

Introduction: CT-scan is the method of choice for major traumaassessment. However, it significantly increases radiation exposure in thepediatric population. The objective of this study was to analyze differ-ences in clinical outcomes according to the preoperative use of CT-scan. Materials and methods: A retrospective observational study ofpediatric patients admitted for trauma and requiring surgery was carriedout. Patients were classified according to the previous use of CT-scan.ICU stay, re-admissions, and deaths were assessed. Results: From 2011 to 2017, 737 patients under 18 years of agewith external lesions were treated, 174 of whom required surgery. 48patients (27.6%) underwent CT-scan prior to the procedure (Group 1),while the remaining 126 patients (72.4%) were directly scheduled forsurgery (Group 2). Penetrating trauma occurred in 81% of patients, theproportion being significantly higher in Group 2 (p= 0.001). Median agewas 15 years (interquartile range: 12-17), with no differences betweengroups. No significant differences were found in terms of hemodynamicinstability at admission between groups (p= 0.596). At surgery, 3 outof 48 patients (6.3%) had no evident lesion. No significant differenceswere found in terms of re-admissions (p= 0.476), mortality (0.994),and ICU stay (0.466). Conclusion: The use of CT-scan as a diagnostic tool in pediatrictrauma does not reduce mortality, ICU stay, or number of re-admissions.The use of tools such as ultrasound examination and simple X-ray shouldbe protocolized to avoid unnecessary exposure to higher radiation doses.Prospective studies confirming this hypothesis are required.(AU)

Comparison of neutron and secondary gamma dose assessment using polygon mesh and voxel computational phantoms.

The newly developed mesh-type reference computational phantoms (MRCPs) represent the evolution of the previous reference phantoms and a more detailed description of the human body, addressing the voxel reference phantom limitations. These allow for a more accurate dose calculation in the human body, which in some cases results in a significant difference of the calculated quantities. In this work, the absorbed dose calculation due to neutrons and gammas was calculated using a voxel and a mesh-type computational phantom. The goal was to understand how a more accurate description of the human body affects the estimated neutron dose. The phantoms were tested in a real-case scenario: they were placed in front of a neutron Howitzer container model using PHITS. This model corresponds to the neutron Howitzer container at the Neutron Measurements Laboratory of the Energy Engineering Department of the Polytechnic University of Madrid (UPM), and at the time of measurement it was equipped with a 241Am-Be neutron source of 74 GBq in its center. The container allows the source to be in either the irradiation or the storage position. Results show that when dealing with neutrons, the dose deviation when using GOLEM or the MRCP leads to a general 20%-30% deviation that goes up to above 400% in small thin structures such as the eye.

Women's Ecofeminist Spirituality: Origins and Applications to Psychotherapy.

The aim of this paper is to theoretically explore the origins and possible psychotherapeutic applications of some neo-pagan, neo-shamanic, or psycho-spiritual women's movements that are currently spreading in Western countries. In spite of their great diversity, they are all encompassed within the term "ecofeminist spirituality." This article analyzes their ideological, historical, and cultural origins, placing special emphasis on their psychotherapeutic role and describing the main tools and fields of application.

Cetoacidosis diabética en adolescente con fibrosis quística / Diabetic ketoacidosis in adolescent with cystic fibrosis

La dificultad respiratoria aguda en pacientes con fibrosis quística puede deberse a causas metabólicas. La alteración del metabolismo hidrocarbonado es una complicación frecuente en estos pacientes. La diabetes relacionada con la fibrosis quística se debe a una disminución en la secreción de insulina secundaria a la insuficiencia pancreática como causa primaria; sin embargo, el tratamiento glucocorticoideo y otros factores (desnutrición, disfunción hepática, infecciones, etc.) pueden intervenir creando resistencia a la insulina. Es imprescindible establecer un control glucémico en las exacerbaciones respiratorias y en pacientes tratados con fármacos hiperglucemiantes como, por ejemplo, los glucocorticoides orales en la aspergilosis broncopulmonar alérgica

Acute respiratory distress in patients with cystic fibrosis may be due to metabolic causes and the alteration of the hydrocarbon metabolism is a frequent complication in these patients. Cystic fibrosis-related diabetes is due to a decrease in insulin secretion secondary to pancreatic insufficiency as the primary cause; however, glucocorticoid treatment and other factors (malnutrition, hepatic dysfunction, infections...) can intervene by creating insulin resistance. Glycemic control is essential in respiratory exacerbations and in patients treated with hyperglycemic drugs, for example oral glucocorticoids as a treatment of allergic bronchopulmonary aspergillosis

The work programme of NERIS in post-accident recovery.

NERIS is the European platform on preparedness for nuclear and radiological emergency response and recovery. Created in 2010 with 57 organisations from 28 different countries, the objectives of the platform are to: improve the effectiveness and coherency of current approaches to preparedness; identify further development needs; improve 'know how' and technical expertise; and establish a forum for dialogue and methodological development. The NERIS Strategic Research Agenda is now structured with three main challenges: (i) radiological impact assessments during all phases of nuclear and radiological events; (ii) countermeasures and countermeasure strategies in emergency and recovery, decision support, and disaster informatics; and (iii) setting up a multi-faceted framework for preparedness for emergency response and recovery. The Fukushima accident has highlighted some key issues for further consideration in NERIS research activities, including: the importance of transparency of decision-making processes at local, regional, and national levels; the key role of access to environmental monitoring; the importance of dealing with uncertainties in assessment and management of the different phases of the accident; the use of modern social media in the exchange of information; the role of stakeholder involvement processes in both emergency and recovery situations; considerations of societal, ethical, and economic aspects; and the reinforcement of education and training for various actors. This paper emphasises the main issues at stake for NERIS for post-accident management.

Is mitotic rate still useful in the management of patients with thin melanoma?

BACKGROUND: T1 melanoma substaging was recently modified by the American Joint Committee on Cancer (AJCC). Although sentinel lymph node (SLN) positivity is the most important prognostic factor in melanoma, there is a lack of consensus on whether SLN biopsy should be performed in patients with thin melanoma (≤1 mm). OBJECTIVE: The main aim of this study was to investigate predictors of SLN positivity in patients with thin melanoma, with a special emphasis on mitotic rate. A secondary aim was to evaluate survival in this group of patients. MATERIALS AND METHODS: Retrospective multicenter observational study with analysis of age, sex, tumour location, thickness, mitotic rate, regression and microscopic satellites. Predictive factors were identified using a classification and regression tree (CART) approach. Melanoma-specific survival according to SLN status was estimated using Kaplan-Meier curves. RESULTS: We analysed 203 patients with a melanoma ≤1 mm. Using the new AJCC staging criteria, the CART algorithm identified a 7.5% likelihood of SLN positivity in T1a patients. In the case of T1b melanoma, there was a 14.3% likelihood of SLN positivity in patients with a mitotic rate >1 mitosis/mm2 and a 3.2% likelihood in those with ≤1 mitoses/mm2 . None of the patients with T1b disease who had ≤1 mitoses/mm2 and regression had SLN positivity. In T1b patients, 5-year melanoma-specific survival was 98.7% in the SLN-negative group and 75% in the SLN-positive group (P = 0.05). When stratified by mitotic rate, survival was 100% for patients with a mitotic rate of ≤1 mitoses/mm2 and 91.4% for those with >1 mitosis/mm2 (P = 0.022). There were no deaths in the T1a subgroup. CONCLUSIONS: Sentinel lymph node metastasis was less common in patients with T1b melanoma who had a mitotic rate of ≤1 mitoses/mm2 . Performance of SLN biopsy should be carefully considered in this subgroup of patients, particularly considering the good prognosis.

HLA-B*57 and IFNL4-related polymorphisms are associated with protection against HIV-1 disease progression in controllers.

Background: HIV-1-controllers maintain HIV-1 viremia at low levels (normally <2000 HIV-RNA copies/mL) without antiretroviral treatment. However, some HIV-1-controllers have evidence of immunologic progression with marked CD4+T-cell decline. We investigated host genetic factors associated with protection against CD4+T-cell loss in HIV-1-controllers. Methods: We analysed the association of interferon lambda 4 (IFNL4)-related polymorphisms and HLA-B haplotypes within Long Term Non-Progressor HIV-1-controllers ((LTNP-C), defined by maintaining CD4+T-cells counts >500 cells/mm3 for more than 7 years after HIV-1 diagnosis) versus non-LTNP-C, who developed CD4+T-cells counts <500 cells/mm3 Both a Spanish study cohort (n=140) and an international validation cohort (n=914) were examined. Additionally, in a subgroup of individuals HIV-1-specific T-cell responses and soluble cytokines were analysed RESULTS: HLA-B*57 was independently associated with the LTNP-C phenotype (OR=3.056 (1.029-9.069) p=0.044 and OR=1.924 (1.252-2.957) p=0.003) while IFNL4 genotypes represented independent factors for becoming non-LTNP-C (TT/TT, ss469415590, OR=0.401 (0.171-0.942) p=0.036 or A/A, rs12980275, OR=0.637 (0.434-0.934) p=0.021) in the Spanish and validation cohort, respectively, after adjusting for sex, age at HIV-1 diagnosis, IFNL4-related polymorphisms and different HLA-B haplotypes. LTNP-C showed lower plasma IP-10 (p=0.019) and higher IFN-γ (p=0.02) levels than the HIV-1-controllers with diminished CD4+T-cell numbers. Moreover, LTNP-C exhibited higher quantities of IL2+CD57- and IFN-γ+CD57- HIV-1-specific CD8+T-cells (p=0.002 and 0.041, respectively) than non-LTNP-C. Conclusions: We have defined genetic markers able to segregate stable HIV-1-controllers from those who experience CD4+T-cell decline. These findings allow for identification of HIV-1-controllers at risk for immunologic progression, and provide avenues for personalized therapeutic interventions and precision medicine for optimizing clinical care of these individuals.

Valoración de la posible transmisión intrafamiliar de bacterias que colonizan a los pacientes con fibrosis quística / Assessment of possible intra-family transmission of bacteria that colonize patients with cystic fibrosis

INTRODUCCIÓN: En la Fibrosis Quística (FQ), la patología broncopulmonar es la más representativa y grave en todo el espectro de la enfermedad, causada principalmente por la colonización persistente de la vía aérea por bacterias con capacidad patogénica. Su control es fundamental para mejorar el pronóstico de estos pacientes. Conocer las fuentes de infección en estos casos permitiría diseñar mejores estrategias para su prevención. OBJETIVOS: Evaluar, en el entorno familiar de pacientes con FQ, la posible transmisión de bacterias que frecuentemente colonizan las vías respiratorias, como Pseudomonas aeruginosa y Streptococcus pneumoniae. MATERIAL Y MÉTODO: Se incluyeron un total de 10 pacientes con FQ y 15 familiares convivientes, de los que se tomaron muestras de esputo y frotis orofaríngeo respectivamente. En ellos se trataron de identificar bacterias mediante técnicas de metagenómica (PCR- DGGE del gen 16S-rRNA para bacterias) y de ampliación de ácidos nucleicos. RESULTADOS: Los resultados del estudio de metagenómica mostraron la presencia de diferentes bacterias en todos los pacientes evaluados, siendo las más frecuentes Pseudomonas spp. (n=9), Streptococcus spp. (n=4), Staphylococcus spp. (n=2) y Haemophilus influenzae (n=2). En los familiares se identificó por PCR Pseudomona aeruginosa en el 46,5% de los casos y S. pneumoniae en el 66,7%. La concordancia entre familiares y pacientes fue del 40% para P. aeruginosa, con coincidencia de genotipos del 100% y una concordancia del 20% para S. pneumoniae. CONCLUSIONES: La presencia de bacterias que frecuentemente colonizan el tracto respiratorio de los pacientes con fibrosis quística es frecuente entre los familiares que cohabitan con ellos, lo que podría facilitar la transmisión de unos sujetos a otros y la persistencia de éstas en el entorno familiar

INTRODUCTION: In Cystic Fibrosis (CF), bronchial-pulmonary pathology is the most representative and serious within the scope of this disease, and generally caused by the persistent colonization of the airways by pathogenic bacteria. Control is essential to improve the prognosis of these patients. In these cases, understanding the source of infection would facilitate the design of improved prevention strategies. OBJECTIVES: Assess, within the family environment of patients with CF, the possible transmission of bacteria that frequently colonize airways, such as Pseudomonas aeruginosa and Streptococcus pneumoniae. MATERIAL AND METHODS: Ten patients with CF were included in this study, as well as 15 cohabiting relatives, from whom sputum samples and oropharyngeal smears were taken respectively. Using metagenomics, the bacteria were identified (PCR- DGGE of the gene16S-rRNAfor bacteria) and the expanding of nucleic acids. RESULTS: The results of the metagenomic study proved the presence of various bacteria in all patients assessed, with the most frequent being Pseudomonas spp. (n=9), Streptococcus spp. (n=4), Staphylococcus spp. (n=2) and Haemophilus influenzae (n=2). Using PCR in the relatives, P. aeruginosa was identified in 46.5% of the cases, and S. pneumoniae in 66.7%. Consistency between relative and patient was 40% for P. aeruginosa, with a 100% genotype coincidence and a 20% consistency for S. pneumoniae. CONCLUSIONS: The presence of bacteria that frequently colonize the respiratory tract in patients with cystic fibrosis is recurrent among relatives cohabiting with them, which could facilitate the transmission of bacteria from one person to another and the persistence of said bacteria within the family environment

The role of daily physical activity and nutritional status on bone turnover in cystic fibrosis: a cross-sectional study.

BACKGROUND: Nutritional status and daily physical activity (PA) may be an excellent tool for the maintenance of bone health in patients with cystic fibrosis (CF). OBJECTIVE: To evaluate the relationship between nutritional status, daily physical activity and bone turnover in cystic fibrosis patients. METHOD: A cross-sectional study of adolescent and adult patients diagnosed with clinically stable cystic fibrosis was conducted. Total body, femoral neck, and lumbar spine bone mineral density (BMD) were determined by dual energy X-ray absorptiometry and bone metabolism markers ALP, P1NP, PICP, and ß-CrossLaps. PA monitoring was assessed for 5 consecutive days using a portable device. Exercise capacity was also determined. Serum 25-hydroxyvitamin D and vitamin K were also determined in all participants. RESULTS: Fifty patients (median age: 24.4 years; range: 16-46) were included. BMI had positive correlation with all BMD parameters, with Spearman's coefficients ranging from 0.31 to 0.47. Total hip bone mineral density and femoral neck BMD had positive correlation with the daily time spent on moderate PA (>4.8 metabolic equivalent-minutes/day; r=0.74, p<0.001 and r=0.72 p<0.001 respectively), daily time spent on vigorous PA (>7.2 metabolic equivalent-minutes/day; r=0.45 p<0.001), body mass index (r=0.44, p=0.001), and muscle mass in limbs (r=0.41, p=0.004). Levels of carboxy-terminal propeptide of type 1 collagen were positively associated with the daily time spent on moderate (r=0.33 p=0.023) and vigorous PA (r=0.53, p<0.001). CONCLUSIONS: BMI and the daily time spent on moderate PA were found to be correlated with femoral neck BMD in CF patients. The association between daily PA and biochemical markers of bone formation suggests that the level of daily PA may be linked to bone health in this patient group. Further research is needed to confirm these findings.

The role of daily physical activity and nutritional status on bone turnover in cystic fibrosis: a cross-sectional study

ABSTRACT Background Nutritional status and daily physical activity (PA) may be an excellent tool for the maintenance of bone health in patients with cystic fibrosis (CF). Objective To evaluate the relationship between nutritional status, daily physical activity and bone turnover in cystic fibrosis patients. Method A cross-sectional study of adolescent and adult patients diagnosed with clinically stable cystic fibrosis was conducted. Total body, femoral neck, and lumbar spine bone mineral density (BMD) were determined by dual energy X-ray absorptiometry and bone metabolism markers ALP, P1NP, PICP, and ß-CrossLaps. PA monitoring was assessed for 5 consecutive days using a portable device. Exercise capacity was also determined. Serum 25-hydroxyvitamin D and vitamin K were also determined in all participants. Results Fifty patients (median age: 24.4 years; range: 16-46) were included. BMI had positive correlation with all BMD parameters, with Spearman’s coefficients ranging from 0.31 to 0.47. Total hip bone mineral density and femoral neck BMD had positive correlation with the daily time spent on moderate PA (>4.8 metabolic equivalent-minutes/day; r=0.74, p<0.001 and r=0.72 p<0.001 respectively), daily time spent on vigorous PA (>7.2 metabolic equivalent-minutes/day; r=0.45 p<0.001), body mass index (r=0.44, p=0.001), and muscle mass in limbs (r=0.41, p=0.004). Levels of carboxy-terminal propeptide of type 1 collagen were positively associated with the daily time spent on moderate (r=0.33 p=0.023) and vigorous PA (r=0.53, p<0.001). Conclusions BMI and the daily time spent on moderate PA were found to be correlated with femoral neck BMD in CF patients. The association between daily PA and biochemical markers of bone formation suggests that the level of daily PA may be linked to bone health in this patient group. Further research is needed to confirm these findings.

Depression and anxiety symptoms in Spanish adult patients with cystic fibrosis: associations with health-related quality of life.

BACKGROUND: Cystic fibrosis (CF) is a chronic disease with an impact on the quality of life. Self-reported symptoms of depression and anxiety were assessed in the Spanish cohort of the International Epidemiological Study on Depression and Anxiety in patients with CF (International Depression-Anxiety Epidemiological Study) and their relationship with health status and health-related quality of life (HRQoL) was evaluated. METHODS: This cross-sectional study recruited adult patients with CF at 10 Spanish centers. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the Revised Cystic Fibrosis Questionnaire. Demographic and health data were recorded from medical charts. Logistic regression was used to determine the predictors of elevated symptoms of depression and anxiety (HADS≥8). RESULTS: Of the 336 participants recruited (mean age, 28.1years; 48.2% women), 41 (12.2%) had elevated depression-related scores, and 100 (29.7%) had elevated anxiety-related scores (HADS≥8). After adjusting for confounders, only less education, intravenous antibiotics, psychiatric medications and psychotherapy were significantly associated with elevated psychological symptoms. Specifically, regardless of lung function, patients who were depressed or anxious reported worse HRQoL. CONCLUSIONS: The prevalence of elevated symptoms of depression and anxiety was high in Spanish adult patients with CF, and these symptoms were associated with a decreased HRQoL.

Factores predictivos del estado del ganglio centinela en el melanoma cutáneo: análisis mediante un árbol de clasificación y regresión / Predictors of Sentinel Lymph Node Status in Cutaneous Melanoma: A Classification and Regression Tree Analysis

OBJETIVO: El objetivo principal de este estudio es identificar factores predictivos de la afectación metastásica del ganglio centinela (GC). Pacientes y método: Se trata de un estudio de cohortes retrospectivo realizado en 2 centros hospitalarios de tercer nivel. Se incluyeron un total de 818 pacientes. La medida de resultado principal fue la afectación del GC. La valoración de predictores independientes de esta afectación se realizó mediante una regresión logística múltiple y un árbol de clasificación y regresión (CART). RESULTADOS: El análisis de regresión logística múltiple mostró que la ulceración, el grosor tumoral y un alto índice mitótico (IM) (≥ 6 mitosis/mm2) se relacionaron con la afectación metastásica del GC de forma independiente. El CART mostró que el grosor de Breslow fue el factor más importante como predictor de la afectación linfática. Para los melanomas gruesos (> 2 mm) las variables predictoras fueron la ausencia de infiltrado inflamatorio, la edad y la localización. Para los melanomas menores de 2 mm las variables predictoras fueron el IM (> 6 mitosis/mm2), la ulceración y el grosor. El grosor tumoral, la edad, la localización y el IM fueron predictores de la supervivencia de estos pacientes. CONCLUSIÓN: Un alto IM se asocia con una mayor afectación metastásica del GC y una peor supervivencia. Con la metodología CART es posible una mejor predicción de la afectación metastásica regional con vistas al mejor manejo clínico de estos pacientes o su inclusión en ensayos clínicos. © 2014 Elsevier España, S.L.U. y AEDV. Todos los derechos reservados

OBJECTIVE: The main aim of this study was to identify predictors of sentinel lymph node (SN) metastasis in cutaneous melanoma. PATIENTS AND METHODS: This was a retrospective cohort study of 818 patients in 2 tertiarylevel hospitals. The primary outcome variable was SN involvement. Independent predictors were identified using multiple logistic regression and a classification and regression tree (CART) analysis. RESULTS: Ulceration, tumor thickness, and a high mitotic rate (≥6 mitoses/mm2) were independently associated with SN metastasis in the multiple regression analysis. The most important predictor in the CART analysis was Breslow thickness. Absence of an inflammatory infiltrate, patient age, and tumor location were predictive of SN metastasis in patients with tumors thicker than 2 mm. In the case of thinner melanomas, the predictors were mitotic rate (> 6 mitoses/mm2), presence of ulceration, and tumor thickness. Patient age, mitotic rate, and tumor thickness and location were predictive of survival. CONCLUSIONS: A high mitotic rate predicts a higher risk of SN involvement and worse survival. CART analysis improves the prediction of regional metastasis, resulting in better clinical management of melanoma patients. It may also help select suitable candidates for inclusion in clinical trials

Predictors of sentinel lymph node status in cutaneous melanoma: a classification and regression tree analysis.

OBJECTIVE: The main aim of this study was to identify predictors of sentinel lymph node (SN) metastasis in cutaneous melanoma. PATIENTS AND METHODS: This was a retrospective cohort study of 818 patients in 2 tertiary-level hospitals. The primary outcome variable was SN involvement. Independent predictors were identified using multiple logistic regression and a classification and regression tree (CART) analysis. RESULTS: Ulceration, tumor thickness, and a high mitotic rate (≥6 mitoses/mm(2)) were independently associated with SN metastasis in the multiple regression analysis. The most important predictor in the CART analysis was Breslow thickness. Absence of an inflammatory infiltrate, patient age, and tumor location were predictive of SN metastasis in patients with tumors thicker than 2mm. In the case of thinner melanomas, the predictors were mitotic rate (>6 mitoses/mm(2)), presence of ulceration, and tumor thickness. Patient age, mitotic rate, and tumor thickness and location were predictive of survival. CONCLUSIONS: A high mitotic rate predicts a higher risk of SN involvement and worse survival. CART analysis improves the prediction of regional metastasis, resulting in better clinical management of melanoma patients. It may also help select suitable candidates for inclusion in clinical trials.

Mapping of the circulating metabolome reveals α-ketoglutarate as a predictor of morbid obesity-associated non-alcoholic fatty liver disease.

BACKGROUND: Obesity severely affects human health, and the accompanying non-alcoholic fatty liver disease (NAFLD) is associated with high morbidity and mortality. Rapid and non-invasive methods to detect this condition may substantially improve clinical care. METHODS: We used liquid and gas chromatography-quadruple time-of-flight-mass spectrometry (LC/GC-QTOF-MS) analysis in a non-targeted metabolomics approach on the plasma from morbidly obese patients undergoing bariatric surgery to gain a comprehensive measure of metabolite levels. On the basis of these findings, we developed a method (GC-QTOF-MS) for the accurate quantification of plasma α-ketoglutarate to explore its potential as a novel biomarker for the detection of NAFLD. RESULTS: Plasma biochemical differences were observed between patients with and without NAFLD indicating that the accumulation of lipids in hepatocytes decreased ß-oxidation energy production, reduced liver function and altered glucose metabolism. The results obtained from the plasma analysis suggest pathophysiological insights that link lipid and glucose disturbances with α-ketoglutarate. Plasma α-ketoglutarate levels are significantly increased in obese patients compared with lean controls. Among obese patients, the measurement of this metabolite differentiates between those with or without NAFLD. Data from the liver were consistent with data from plasma. Clinical utility was assessed, and the results revealed that plasma α-ketoglutarate is a fair-to-good biomarker in patients (n=230). Other common laboratory liver tests used in routine application did not favourably compare. CONCLUSION: Plasma α-ketoglutarate is superior to common liver function tests in obese patients as a surrogate biomarker of NAFLD. The measurement of this biomarker may potentiate the search for a therapeutic approach, may decrease the need for liver biopsy and may be useful in the assessment of disease progression.

Units related to radiation exposure and radioactivity in mass media: the Fukushima case study in Europe and Russia.

Using an analysis of the way European newspapers covered the Fukushima nuclear accident, this article explores how the mass media transmit information about radiation risks from experts to the general public. The study applied a media content analysis method on a total of 1340 articles from 12 leading newspapers in 6 countries: Belgium (N = 260), Italy (N = 270), Norway (N = 133), Russia (N = 172), Slovenia (N = 190) and Spain (N = 315). All articles analysed were selected as being directly or indirectly related to the Fukushima accident by containing the word 'nuclear' and/or 'Fukushima' and were published between the 11th March and the 11th May 2011. The data presented here focus specifically on a cross-cultural comparison of the way the media use quantitative units. Results suggest that although experts are accustomed to communicating about radiological risks in technical language, often using quantitative units to describe the risks, mass media do not tend to use these units in their reporting. Although the study found a large variation in the measurement units used in different countries, it appeared that journalists in all the analysed countries preferred to describe radioactivity by comparing different radiation exposures, rather than reporting the actual measured units. The paper concludes with some practical guidelines for sound public communication about radiation risks.

Hemorragia digestiva secundaria a hemobilia por fístula arteriobiliar criptogenética / Digestive bleeding secondary to hemobilia due to cryptogenic arteriobiliary fistula

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