Spanish radiology residents' views on breast imaging.

OBJECTIVE: To evaluate radiology residents' opinions about breast imaging and the possibility of choosing this subspecialty after completing their residency. MATERIAL AND METHODS: We elaborated a 15-question survey aimed at radiology residents in Spain. The survey was approved by the Spanish Society of Breast Imaging (SEDIM) and the Spanish Society of Medical Radiology (SERAM), and it was disseminated by the SERAM through links to Google Forms via social networks and emails. Responses sent between February 21, 2020 and July 31, 2020 were accepted. RESULTS: A total of 72 residents responded to the survey (7.83% response rate); 69.44% of these were third- or fourth-year residents. Of the respondents, 73.61% knew about the SEDIM, and 18.06% knew about the European Society of Breast Imaging. The duration of training programs was three months for 70.83% of respondents. In 7.84% of the responses, residents stated that their supervision was less than 50%, and 70.59% of the residents stated that the rotation exceeded their expectations. One-third of the respondents would consider a fellowship in breast imaging. In all hospitals, residents did diagnostic mammography and breast ultrasound; not all did interventional procedures. Aspects of breast imaging that were rated negatively included the lack of CT studies and the possible legal repercussions of errors. Aspects that were rated positively were dynamics, interventionism, and the role of the radiologist in the process of care for patients with breast cancer. CONCLUSIONS: Most residents considered that their rotations in breast imaging exceeded their expectations; however, only a small percentage of residents would consider specializing in the field.

Spanish radiology residents' views on breast imaging. / Visión del residente de radiodiagnóstico en España sobre la radiología mamaria.

OBJECTIVE: To evaluate radiology residents' opinions about breast imaging and the possibility of choosing this subspecialty after completing their residency. MATERIAL AND METHODS: We elaborated a 15-question survey aimed at radiology residents in Spain. The survey was approved by the Spanish Society of Breast Imaging (SEDIM) and the Spanish Society of Medical Radiology (SERAM), and it was disseminated by the SERAM through links to Google Forms via social networks and emails. Responses sent between February 21, 2020 and July 31, 2020 were accepted. RESULTS: A total of 72 residents responded to the survey (7.83% response rate); 69.44% of these were third- or fourth-year residents. Of the respondents, 73.61% knew about the SEDIM, and 18.06% knew about the European Society of Breast Imaging. The duration of training programs was three months for 70.83% of respondents. In 7.84% of the responses, residents stated that their supervision was less than 50%, and 70.59% of the residents stated that the rotation exceeded their expectations. One-third of the respondents would consider a fellowship in breast imaging. In all hospitals, residents did diagnostic mammography and breast ultrasound; not all did interventional procedures. Aspects of breast imaging that were rated negatively included the lack of CT studies and the possible legal repercussions of errors. Aspects that were rated positively were dynamics, interventionism, and the role of the radiologist in the process of care for patients with breast cancer. CONCLUSIONS: Most residents considered that their rotations in breast imaging exceeded their expectations; however, only a small percentage of residents would consider specializing in the field.

Clinical assessment of tolerability, immunological and cutaneous reactivity effects of an abbreviated schedule with Olea europaeanative extract of subcutaneous immunotherapy.

Summary: Objectives. To evaluate the tolerability and efficacy of Olea europaea subcutaneous immunotherapy (SCIT) on patients with rhinoconjunctivitis. Methods. In this open clinical trial patients were assigned to an abbreviated build-up scheme. The outcomes were: number, percentage, and severity of adverse reactions. Secondary outcomes included: changes in immunoglobulin titers and changes in dose-response skin prick tests. Results. Only 8 systemic reactions were registered, which represented 7/47 (14.9%) of patients and 8/429 (1.9%) of administered doses. Regarding immunological parameters the significant increases of sIgG and sIgG4 evidenced the changes in the patient immune system. Cutaneous reactivity decreased significantly. Conclusions. Olea europaea SCIT (Allergovac® depot ROXALL Medicina España S.A.) showed a good safety and tolerability profile. Immunological changes with induction of blocking IgG and decreases in cutaneous reactivity were detected in the patients.

Analysis of the management of antipsychotics in a group of prisons.

Objective: To assess the use of prescribed antipsychotic treatments in the Spanish prison population in order to determine whether there are differences in efficacy and cost between the different long-acting antipsychotic injectables (LAIs). Material and method: An observational, retrospective study was carried out in twelve prisons and in two prison psychiatric hospitals. To assess efficacy, all the clinical histories of patients with some kind of LAI were reviewed and only those who were in a situation of therapeutic stability were selected, defined as those treatments that had not undergone any change in the three last months, both in doses and in the association of another antipsychotic. Results: Of the 11,953 inmates included in the study, 1,851 (15.5%) received prescriptions for an antipsychotic, 415 in penitentiary psychiatric hospitals (87%) and 1,436 in prisons (12%), which is a much higher prevalence than that found in the population. Regarding the prescription pattern of LAIs, paliperidone is the most widely prescribed in prison psychiatric hospitals and prisons, followed by aripiprazole, zuclopenthixol and risperidone. Finally flufenazine, olanzapine and paliperidone quarterly, which are scarcely represented. Of the 292 patients with LAI, 41% (121 patients) are with monotherapy and 59% (171 patients) are with polytherapy, which is similar to the data found in the bibliography. Discussion: The use of prescribed LAIs amongst inmates is widespread. Polytherapy is also a common phenomenon, although there is a downward trend due to the use of more recently marketed drugs. Since the use of LAI is long-term, with numerous side effects and a wide range of prices, it is essential to consider the patient's risk factors and the cost of treatment alongside the therapeutic efficacy.

Cognitive predictors of illness course at 12 months after first-episode of depression.

Major Depressive Disorder (MDD) entails cognitive dysfunction in many cognitive domains, but it is still uncertain whether such deficits are present in the early stages. The purpose of the study is to determine the cognitive performance in first episode depression (FED) exploring the presence of different cognitive profiles, and the role of cognition in FED at baseline and long-term. Ninety subjects (18-50 years) were included, 50 patients with a FED and 40 healthy controls. Participants were assessed with a neuropsychological battery, covering language, attention, verbal memory, processing speed and executive domains. Neuropsychological group comparisons were performed with MANOVAs. A hierarchical cluster analysis was run to identify clusters of patients with similar neuropsychological performance. Two generalized linear models were built to predict baseline HDRS-17 and changes at 12 months. Patients performed significantly worse than healthy controls in language, attention/working memory, verbal memory, processing speed and executive functioning, with moderate to large effect sizes (0.5 - 1). Two clusters were found: cognitively preserved patients (n=37) and cognitively impaired patients (n=13). Large effect sizes of cognitive impairment in FED were observed between the two cognitive clusters (preserved and impaired). Depressive symptoms at baseline were predicted by verbal memory (p=0.003), while 12-month changes were predicted by executive function (p=0.041) and language (p=0.037). Cognitive performance predicted depressive symptoms at baseline and at follow-up, pointing to the usefulness of cognitive assessment even at the commencement of the illness.

A preliminary longitudinal study on the cognitive and functional outcome of bipolar excellent lithium responders.

BACKGROUND: Neurocognitive dysfunction in bipolar disorder represents a possible marker of underlying pathophysiology, but to date, most studies are cross-sectional and heterogeneous with regard to pharmacological treatments. In the present study we investigated the 6-year cognitive and functional outcome of a sample of euthymic excellent lithium responders (ELR). METHOD: A total sample of twenty subjects was assessed at baseline and 6years later: ten diagnosed of bipolar disorder according to DSM-IV criteria and ten healthy matched controls. The sample size was enough to find statistical differences between groups, with a statistical power of 0.8. Bipolar patients were on lithium treatment during all this follow-up period and fulfilled ELR criteria as measured by the Alda scale. A neuropsychological test battery tapping into the main cognitive domains was used at baseline and at after 6-year of follow-up. Functional outcome was evaluated by means of the Functioning Assessment Short Test at study endpoint. RESULTS: Repeated measures multivariate analyses of variance showed that bipolar patients were cognitively impaired in the executive functioning, inhibition, processing speed and verbal memory domains (p<0.03) compared to controls and such deficits were stable over time. Longer duration of illness and lower psychosocial outcome were significantly related to cognitive impairment (p<0.05). CONCLUSIONS: Cognitive dysfunction was present even in euthymic ELR. These deficits remain stable over the long term, and are basically associated with greater symptoms and poorer psychosocial adjustment.

Asenapine prescribing patterns in the treatment of manic in- and outpatients: Results from the MANACOR study.

BACKGROUND: Asenapine is the most recent compound that has been FDA- and EMA-approved for treatment of mania. Its efficacy and safety have been assessed in placebo-controlled trials, but little is known about its performance in routine clinical conditions. In this study, we compared features of patients treated with adjunctive asenapine or other adjunctive antipsychotics and the costs of the treatment. METHODS: A combined prospective and retrospective data collection and analysis was conducted from January 2011 to December 2013 following a clinical interview and assessment of manic and depressive symptoms (YMRS, HDRS-17), clinical state (CGI-BP-M), psychosocial functioning (FAST), sexual dysfunction (PRSexDQ) and health resource costs associated with treatment with adjunctive asenapine versus other adjunctive antipsychotics. RESULTS: Hundred and fifty-two patients from different university hospitals were included. Fifty-three patients received adjunctive asenapine and 99 received other adjunctive antipsychotics concomitantly to mood stabilizers. Considering inpatients, those treated with adjunctive asenapine presented a significantly less severe manic episode (P=0.001), less psychotic symptoms (P=0.030) and more comorbid personality disorder (P=0.002). Regarding outpatients, those treated with adjunctive asenapine showed significantly less severe manic episode (P=0.046), more previous mixed episodes (P=0.013) and more sexual dysfunction at baseline (P=0.036). No significant differences were found in mean total costs per day. CONCLUSION: Clinicians tended to use adjunctive asenapine in patients with less severe manic symptoms but more complex clinical profile, including more mixed episodes in the past, concomitant personality disorder, and sexual problems. Treatment with adjunctive asenapine was not associated with higher costs when compared to other options.

Plasmocitoma de mama, a propósito de un caso / Breast plasmacytoma, apropos of a case

No disponible

Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: an individual patient data meta-analysis.

OBJECTIVE: An association between bipolar disorder and cognitive impairment has repeatedly been described, even for euthymic patients. Findings are inconsistent both across primary studies and previous meta-analyses. This study reanalysed 31 primary data sets as a single large sample (N = 2876) to provide a more definitive view. METHOD: Individual patient and control data were obtained from original authors for 11 measures from four common neuropsychological tests: California or Rey Verbal Learning Task (VLT), Trail Making Test (TMT), Digit Span and/or Wisconsin Card Sorting Task. RESULTS: Impairments were found for all 11 test-measures in the bipolar group after controlling for age, IQ and gender (Ps ≤ 0.001, E.S. = 0.26-0.63). Residual mood symptoms confound this result but cannot account for the effect sizes found. Impairments also seem unrelated to drug treatment. Some test-measures were weakly correlated with illness severity measures suggesting that some impairments may track illness progression. CONCLUSION: This reanalysis supports VLT, Digit Span and TMT as robust measures of cognitive impairments in bipolar disorder patients. The heterogeneity of some test results explains previous differences in meta-analyses. Better controlling for confounds suggests deficits may be smaller than previously reported but should be tracked longitudinally across illness progression and treatment.

Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study.

BACKGROUND: Previous cross-sectional studies report that cognitive impairment is associated with poor psychosocial functioning in euthymic bipolar patients. There is a lack of long-term studies to determine the course of cognitive impairment and its impact on functional outcome. Method A total of 54 subjects were assessed at baseline and 6 years later; 28 had DSM-IV TR bipolar I or II disorder (recruited, at baseline, from a Lithium Clinic Program) and 26 were healthy matched controls. They were all assessed with a cognitive battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory) twice over a 6-year follow-up period. All patients were euthymic (Hamilton Rating Scale for Depression score lower than 8 and Young mania rating scale score lower than 6) for at least 3 months before both evaluations. At the end of follow-up, psychosocial functioning was also evaluated by means of the Functioning Assessment Short Test. RESULTS: Repeated-measures multivariate analysis of covariance showed that there were main effects of group in the executive domain, in the inhibition domain, in the processing speed domain, and in the verbal memory domain (p<0.04). Among the clinical factors, only longer illness duration was significantly related to slow processing (p=0.01), whereas strong relationships were observed between impoverished cognition along time and poorer psychosocial functioning (p<0.05). CONCLUSIONS: Executive functioning, inhibition, processing speed and verbal memory were impaired in euthymic bipolar out-patients. Although cognitive deficits remained stable on average throughout the follow-up, they had enduring negative effects on psychosocial adaptation of patients.

Role of quantity and quality of fat in meat models inoculated with Listeria innocua or Salmonella Typhimurium treated by high pressure and refrigerated stored.

Several variables can influence the effects of high hydrostatic pressure processing (HPP), but the role of fat in the treated sample is still uncertain. We designed a model by which controlling the known variables we could elucidate that role. We applied 400 MPa for 2 min to minced chicken samples inoculated with Listeria innocua and Salmonella Typhimurium mixed with 10% and 20% of three fat types with different fatty acid composition. Microbial counts were performed during 60 days of refrigerated storage either at 2 degrees C or 8 degrees C. Immediately after HPP bacterial growth was independent of the type and percentage of fat content, but a possible effect of type of fat could be observed after 60 days of cold storage.

Neuropsychological profile in bipolar disorder: a preliminary study of monotherapy lithium-treated euthymic bipolar patients evaluated at a 2-year interval.

OBJECTIVE: To investigate the cognitive impairment of a sample of euthymic bipolar patients treated with lithium monotherapy at baseline in a 2-year longitudinal study. METHOD: Fifteen DSM-IV-TR bipolar out-patients and 15 healthy-matched controls were cognitively assessed twice over a 2-year follow-up. All patients underwent lithium monotherapy on the first evaluation, and they were euthymic in both evaluations. Cognitive assessment was performed by means of a neuropsychological test battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory). RESULTS: Repeated measures multivariate analysis of variance showed that the bipolar disorder group was cognitively impaired in the executive domain, attention and processing speed, and such deficits were maintained over time. CONCLUSION: Our results showed that executive dysfunction is the main long-term neuropsychological deficit of bipolar disorder. Also, the persistence of these deficits did not seem to be influenced by any clinical or pharmacological variables.

Use of antioxidants to minimize rancidity in pressurized and cooked chicken slurries.

Sodium chloride (5%) and some antioxidants (400 ppm rosemary extract; 2000 ppm acerola extract; 50 ppm ethylenediamine tetraacetic acid (EDTA); 1,000, 2,000, and 5,000 pm of sodium hexametaphosphate or 5 and 10% egg white powder) were added to minced chicken. From these mixtures, slurries were made by mixing with water (1:3) at 15,000 rpm for 30 s at 20 °C. Samples were pressurized (300, 500 and 900 MPa for 30 min at 20 °C) or cooked (90 °C for 15 min). Hexanal was quantified by solid phase microextraction at 1, 3, 6 and 9 days of 4 °C storage in contact with air. Hexanal values increased with pressure and storage time. Cooked slurries had higher hexanal contents than samples pressurized at 300 MPa, but lower than those treated at 500 and 900 MPa. Rosemary extract was an antioxidant for pressure-treated samples, but had little effect on cooked ones. Acerola extract was not an effective antioxidant, but EDTA strongly inhibited oxidation. Hexamethaphosphate also showed antioxidant ability. Egg white powder inhibited hexanal generation, which can be a new way for revalorizing egg constituents.

Lipid oxidation of pressurized and cooked chicken: role of sodium chloride and mechanical processing on TBARS and hexanal values.

Lipid oxidation of pressurized (300 and 500 MPa for 30 min at 20 °C) or cooked (90 °C for 15 min) minced chicken breast and slurries was evaluated. Mechanical processing, before and after pressurization and cooking, and addition of sodium chloride were also tested as prooxidant factors. At 1, 3, 6 and 9 days of storage at 4 °C, thiobarbituric acid reactive substances (TBARS) and hexanal were quantified by means of the TBARS test and solid phase microextraction, respectively. In general, pressurized samples presented less oxidation compounds than cooked samples. Thiobarbituric acid reactive substances and hexanal values tended to rise with increasing storage time. Both parameters showed similar patterns throughout the experiment. Salt and mechanical processing had greater prooxidant effect on pressurized samples. Pre-treatment slurries presented more oxidation than post-treatment slurries.

High pressure processing applied to cooked sausage manufacture: physical properties and sensory analysis.

Vacuum-packaged cooked sausages were treated at 500 MPa for 5 or 15 min at mild temperature (65 °C). Colour, texture and yield of pressure-treated sausages were evaluated, and compared to those of sausages treated with a conventional heat pasteurisation (80-85 °C for 40 min). Colour attributes did not change. Pressurised sausages were more cohesive and less firm than heat-treated sausages. Pressure treatment induced higher yield than heat treatment. Sensory analysis was also carried out. In some cases, the sensory panel did not detect differences between both types of sausages; and when there were differences, pressurised samples were preferred in more occasions because of their better appearance, taste and, especially, texture. High pressure processing can replace the second industrial heat treatment of cooked sausages.

No clinical evidence of acute opioid tolerance after remifentanil-based anaesthesia.

We have prospectively assessed whether remifentanil-based anaesthesia is associated with clinically relevant acute opioid tolerance, expressed as greater postoperative pain scores or morphine consumption. Sixty patients undergoing elective gynaecological, non-laparoscopic, surgery were randomly assigned to receive remifentanil (group R, n=30) or sevoflurane (group S, n=30) based anaesthesia. Postoperative analgesia was provided with morphine through a patient-controlled infusion device. Mean (SD) remifentanil infusion rate in group R was 0.23 (0.10) microg kg(-1) min(-1) and mean inspired fraction of sevoflurane in group S was 1.75 (0.70)%. Mean (SD) cumulative morphine consumption during the first 24 postoperative hours was similar between groups: 28.0 (14.2) mg (group R) vs 28.6 (12.4) mg (group S). Pain scores, were also similar between groups during this period. These data do not support the development of acute opioid tolerance after remifentanil-based anaesthesia in this type of surgery.

Salmonella enteritidis and aerobic mesophiles in inoculated poultry sausages manufactured with high-pressure processing.

Salmonella enteritidis-inoculated poultry sausages were pressurized at 500 MPa by combining different times (10 and 30 min) and temperatures (50, 60 and 70 degrees C) or heat treated with the same temperature-time combinations and a standard cooking (75 degrees C for 30 min). Counts of Salm. enteritidis and mesophilic bacteria were determined. Most pressure treatments generated statistically higher reductions than the corresponding heat treatments alone. Lethalities of about 7.5 and 6.5 log cfu g(-1) for Salm. enteritidis and mesophiles, respectively, were found in pressurized sausages. There was no significant difference in counts between pressurization at 60 degrees C for 30 min or at 70 degrees C and the standard cooking. High-pressure processing is a suitable alternative method in poultry sausage manufacture.

High-pressure processing applied to cooked sausages: bacterial populations during chilled storage.

Vacuum-packaged cooked sausages were pressurized at 500 MPa for 5 or 15 min at mild temperature (65 degrees C) and later stored at 2 and 8 degrees C for 18 weeks. Counts of aerobic mesophiles and psychrotrophs, lactic acid bacteria, enterobacteria, Baird-Parker microbiota, and Listeria spp. were determined 1 day and 3, 6, 9, 12, 15, and 18 weeks after treatment and compared with those of cooked sausages treated at 80 to 85 degrees C for 40 min. Pressurization generated reductions of about 4 log CFU/g in psychrotrophs and lactic acid bacteria. Enterobacteria and Listeria proved the most pressure sensitive; insignificant or no growth was detected throughout the study. Heat treatment inactivated psychrotrophs and enterobacteria similarly to pressure treatment. Listeria monocytogenes and enterotoxigenic Staphylococcus aureus were not found in treated samples. In general, there was no significant difference in counts of any bacterial populations either among treatments or between storage temperatures. High-pressure processing at mild temperature is an effective preservation method that can replace heat pasteurization applied to some cooked meat and poultry products after packaging.

Pressure- vs. heat-induced bacterial stress in cooked poultry sausages: a preliminary study.

Vacuum-packaged poultry cooked sausages were pressure-treated at 500 MPa by combinations of time (5-45 min) and temperature (2-80 degrees C) and later stored at 6-8 degrees C for 12 we. Mesophile and psychrotrophe counts were determined 1 d, 3, 6, 9 and 12 we after treatment and compared with those of cooked sausages pasteurized at 80-85 degrees C for 40 min. Both pressure and heat treatments offer great possibilities for preservation. Sausages pressurized at 65 degrees C for 15 min showed mesophile numbers below 2 log cfu g(-1) throughout the chill storage. Pressurization, unlike heat treatment, causes a reversible bacterial stress. Thus, injured cells recovered during storage and, at 6 and 12 we, after a temperature abuse (room temperature for approx. 24 h), counts increased up to 6.5 - 7.5 log units. Psychrotrophes were more sensitive to both treatments; no growth was detected the day after (a lethality of more than 4 log units).