Sincronismo muscular en patrones de movimiento de miembros superiores descritos por Kabat: latencia al inicio del pico de la máxima activación electromiográfica / Muscle timing in upper limb movement patterns described by Kabat: Latency at the beginning of the peak of maximum electromyographic activation

Introducción El método Kabat sostiene que el sincronismo normal se produce de distal a proximal, lo cual requiere evidencia electromiográfica. Objetivo Describir el sincronismo muscular de patrones motores de miembros superiores descritos por Kabat, en posiciones sedente y supina, a partir de la medición de la latencia al inicio del pico de la máxima activación electromiográfica (IPMA-EMG) de músculos seleccionados. Material y métodos Se realizó un estudio analítico comparativo. Se evaluó a 20 hombres y 20 mujeres entre 19 y 26 años. Cada participante realizó 3repeticiones activas sin resistencia externa de cada uno de los patrones de movimiento (flexor y extensor) de las 2diagonales. Se registró la latencia del IPMA-EMG para cada uno de los 8músculos evaluados en los 4patrones de movimiento, tanto en supino como en sedente. Estos se promediaron y se ordenaron de menor a mayor para obtener la secuencia de contracciones musculares en cada patrón de movimiento. Se compararon las secuencias obtenidas para cada patrón en sedente y supino y se valoró la existencia de correlaciones entre ellas. Resultados Se observó correlación significativa en las secuencias del IPMA-EMG entre posiciones supina y sedente, en todos los patrones de movimiento (p<0,05), excepto en el patrón extensor de la primera diagonal (p=0,139). No hubo diferencias estadísticamente significativas entre posiciones en ninguno de los patrones (p>0,05). Conclusiones Aunque con variaciones en la IPMA-EMG, se halló, en general, un sincronismo muscular de proximal a distal, más evidenciado en la posición sedente y en los patrones flexores (AU)

Introduction The Kabat method argues that normal synchronism occurs from distal to proximal, which requires electromyographic evidence. Objective To describe the muscular timing of motor patterns of the upper limbs described by Kabat, in seated and supine positions, from the measurement of the latency at the beginning of the peak of the maximum electromyographic activation (BPM-EMG-A) of selected muscles. Material and methods A comparative analytical study was carried out. Twenty men and 20 women between 19 and 26 years old were evaluated. Each participant performed 3active repetitions without external resistance of each of the movement patterns (flexor and extensor) of the 2diagonals. BPM-EMG-A latency was recorded for each of the 8muscles tested in the 4movement patterns, both supine and seated. These were averaged and ordered from lowest to highest to obtain the sequence of muscle contractions in each movement pattern. The sequences obtained for each pattern in seated and supine were compared and the existence of correlations between them was assessed. Results Significant correlation was observed in the BPM-EMG-A sequences between supine and seated positions, in all movement patterns (P<0.05), except in the extensor pattern of the first diagonal (P=0.139). There were no statistically significant differences between positions in any of the patterns (P>0.05). Conclusion Although with variations in BPM-EMG-A, muscle timing was generally found from proximal to distal, more evident in the sitting position and in flexor patterns (AU)

Major Fusarium species and mycotoxins associated with freshly harvested maize grain in Uruguay.

Fusarium species are common fungal pathogens of maize. Fusarium graminearum and Fusarium verticillioides, among others, can cause maize ear rot, and they are also mycotoxin producers. The aims of this work were to determine the frequency and diversity of Fusarium species in Uruguayan maize kernels, evaluate the toxigenic potential of the isolates, determine toxin contamination levels on freshly harvested grain, and assess the sensitivity of main Fusarium species against fungicides. Fusarium verticillioides was the most frequent species isolated, followed by Fusarium graminearum sensu stricto. Of F. verticillioides isolates studied for fumonisin production, 72% produced fumonisin B1 and 32% fumonisin B2. Considering in vitro toxin production by F. graminearum sensu stricto isolates, deoxynivalenol was the main toxin produced, followed by zearalenone and nivalenol. Fumonisins were the most frequently found toxins on freshly harvested maize samples (98% in 2018 and 86% in 2019), and also, fumonisin B1 was the toxin with highest concentration in both years studied (4860 µg/kg in 2018 and 1453 µg/kg in 2019). Deoxynivalenol and zearalenone were also found as contaminants. Metconazole and epoxiconazole were the most effective fungicides tested on F. verticillioides isolates. Fusarium graminearum sensu stricto isolates also were more sensitive to metconazole compared to other fungicides; nevertheless, epoxiconazole was less efficient in controlling this species. This is the first study that reports Fusarium species and mycotoxin contamination levels associated with maize grain in Uruguay. Its detection is the main step to develop management strategies in order to minimize fungal infection in maize crops.

Endourological treatment of ectopic ureterocele. Our experience in the last 15 years. / Tratamiento endourológico del ureterocele ectópico. Experiencia en los últimos 15 años.

OBJECTIVE: To assess the efficacy of the endourological treatment of ectopic ureterocele in children in a large series and with a long-term follow-up. MATERIALS AND METHODS: A retrospective, descriptive study of patients with ectopic ureterocele who had undergone surgery in our institution in the last 15 years was carried out. All patients were treated using an endourological approach, both for ureterocele and postoperative vesicoureteral reflux (VUR). RESULTS: 40 patients were treated -55% with left involvement and 5% with bilateral involvement. Mean age at diagnosis was 4.97 months, with diagnosis being established prenatally in 54.1% of cases. In all patients but one, endourological puncture of the ureterocele was conducted. Mean age at surgery was 6.96 months (0-1.11). Surgery was performed on an outpatient basis in 94.9% of patients. No perioperative complications were recorded. In the last 30 patients, preoperative voiding cystourethrography was not carried out. 72.5% of patients had postoperative VUR (44.8% into the upper pyelon, 10.3% into the lower pyelon, 17.2% into both, 6.9% into the contralateral system, and 20.7% into the bilateral system), but it was resolved with a single endoscopic procedure in 48.1% of cases (65% of patients were healed with two procedures). VUR was not endoscopically resolved in 3 patients who required ureteral re-implantation. 6 patients required heminephrectomy (n=3) or nephrectomy (n=3) as a result of functional impairment and infections. CONCLUSION: The endourological treatment of ectopic ureterocele is a little aggressive and little invasive technique that allows the obstruction to be resolved on an outpatient basis, which means bladder surgery -if required- can be performed outside the neonatal period.

OBJETIVO: Evaluar la eficacia del tratamiento endourológico del ureterocele ectópico en niños en una serie amplia y con seguimiento a largo plazo. MATERIAL Y METODOS: Estudio retrospectivo descriptivo de los pacientes con ureterocele ectópico intervenidos en nuestro centro en los últimos 15 años. Todos los pacientes se tratan por vía endourológica, tanto el ureterocele como el reflujo vesicoureteral (RVU) postoperatorio. RESULTADOS: Se trataron 40 pacientes, 55% eran izquierdos y 5% bilaterales. La edad media al diagnóstico fue de 4,97 meses siendo de diagnóstico prenatal el 54,1%. En todos los pacientes menos uno se realizó una punción endourológica del ureterocele. La edad media en el momento de la cirugía era de 6,96 meses (0-1,11). La cirugía fue ambulante en un 94,9% de los pacientes. No se registraron complicaciones perioperatorias. En los últimos 30 pacientes no se realizó cistouretrografía miccional preoperatoria. Un 72,5% de los pacientes presentaron RVU postoperatorio (44,8% a pielón superior, 10,3% a pielón inferior, 17,2% a ambos, 6,9% al sistema contralateral y 20,7% bilateral), pero este se resolvió con un único procedimiento endoscópico en un 48,1% de los casos (curación del 65% de los pacientes con dos procedimientos). El RVU no se resolvió de forma endoscópica en 3 pacientes que requirieron un reimplante ureteral. Seis pacientes precisaron heminefrectomía (n= 3) o nefrectomía (n= 3) por anulación funcional e infecciones. CONCLUSION: El tratamiento endourológico del ureterocele ectópico es una técnica poco agresiva invasiva que consigue la resolución de la obstrucción de forma ambulante permitiendo diferir la cirugía vesical (si fuera necesaria) fuera del periodo neonatal.

Tratamiento endourológico del ureterocele ectópico. Experiencia en los últimos 15 años / Endourological treatment of ectopic ureterocele. Our experience in the last 15 years

Objetivo: Evaluar la eficacia del tratamiento endourológico delureterocele ectópico en niños en una serie amplia y con seguimientoa largo plazo. Material y métodos: Estudio retrospectivo descriptivo de los pacientes con ureterocele ectópico intervenidos en nuestro centro en losúltimos 15 años. Todos los pacientes se tratan por vía endourológica,tanto el ureterocele como el reflujo vesicoureteral (RVU) postoperatorio. Resultados: Se trataron 40 pacientes, 55% eran izquierdos y 5%bilaterales. La edad media al diagnóstico fue de 4,97 meses siendo dediagnóstico prenatal el 54,1%. En todos los pacientes menos uno serealizó una punción endourológica del ureterocele. La edad media enel momento de la cirugía era de 6,96 meses (0-1,11). La cirugía fue ambulante en un 94,9% de los pacientes. No se registraron complicacionesperioperatorias. En los últimos 30 pacientes no se realizó cistouretrografía miccional preoperatoria. Un 72,5% de los pacientes presentaron RVUpostoperatorio (44,8% a pielón superior, 10,3% a pielón inferior, 17,2%a ambos, 6,9% al sistema contralateral y 20,7% bilateral), pero este seresolvió con un único procedimiento endoscópico en un 48,1% de loscasos (curación del 65% de los pacientes con dos procedimientos). ElRVU no se resolvió de forma endoscópica en 3 pacientes que requirieronun reimplante ureteral. Seis pacientes precisaron heminefrectomía (n= 3)o nefrectomía (n= 3) por anulación funcional e infecciones. Conclusión: El tratamiento endourológico del ureterocele ectópicoes una técnica poco agresiva invasiva que consigue la resolución de laobstrucción de forma ambulante permitiendo diferir la cirugía vesical(si fuera necesaria) fuera del periodo neonatal.(AU)

Objective: To assess the efficacy of the endourological treatmentof ectopic ureterocele in children in a large series and with a long-termfollow-up. Materials and methods: A retrospective, descriptive study ofpatients with ectopic ureterocele who had undergone surgery in ourinstitution in the last 15 years was carried out. All patients were treatedusing an endourological approach, both for ureterocele and postoperativevesicoureteral reflux (VUR). Results: 40 patients were treated – 55% with left involvement and5% with bilateral involvement. Mean age at diagnosis was 4.97 months,with diagnosis being established prenatally in 54.1% of cases. In allpatients but one, endourological puncture of the ureterocele was conducted. Mean age at surgery was 6.96 months (0-1.11). Surgery wasperformed on an outpatient basis in 94.9% of patients. No perioperativecomplications were recorded. In the last 30 patients, preoperative voidingcystourethrography was not carried out. 72.5% of patients had postoper-ative VUR (44.8% into the upper pyelon, 10.3% into the lower pyelon,17.2% into both, 6.9% into the contralateral system, and 20.7% into thebilateral system), but it was resolved with a single endoscopic procedurein 48.1% of cases (65% of patients were healed with two procedures).VUR was not endoscopically resolved in 3 patients who required ureteral remplantation. 6 patients required heminephrectomy (n=3) ornephrectomy (n=3) as a result of functional impairment and infections. Conclusion: The endourological treatment of ectopic ureterocele isa little aggressive and little invasive technique that allows the obstructionto be resolved on an outpatient basis, which means bladder surgery – ifrequired – can be performed outside the neonatal period.(AU)

Frailty as a predictor of clinical problems and events that require elderly patients with heart failure to use health resources.

BACKGROUND: The clinical management of elderly patients with heart failure (HF) is not firmly established. Decision-making should be individualized depending on the biological deterioration of each patient, from aggressive management to a palliative approach. Frailty can serve as the basis for this comprehensive individualized management. Our objective was to evaluate the importance of the main clinical problems, as well as the events that required the use of health resources, based the degree of frailty, in elderly patients with HF. METHODS AND RESULTS: Retrospective observational cohort study. Frailty was defined according to the deficit accumulation construct. A total of 546 patients hospitalized for acute HF were included. The median age (Q1-Q3) was 82 (78-86) years. A total of 454 patients (83%) showed some degree of frailty: 221 (48.7%) mild, 207 (45.6%) moderate and 26 (5.7%) advanced. There was a significant tendency towards polypharmacy from no to severe frailty. Hospital events were recorded for 4 (1-6) patients with mild frailty, 4 (2-6) patients with moderate frailty and 2 ((1-4) patients with advanced frailty (p = 0.045). A total of 204 patients (37.4%) died during follow-up. The median time to death was 11.4 (4-16.8), 6.7 (3.3-11.6), 6.5 (3.4-12.2) and 4.1 (0.8-7.7) months for patients with no, mild, moderate, or advanced frailty, respectively (p = 0.006). CONCLUSIONS: Frailty due to deficit accumulation is a good predictor of clinical problems and events that require the use of health resources; therefore, it can serve as a basis for the management of HF in the elderly.

High chromosomal mobility of rDNA clusters in holocentric chromosomes of Triatominae, vectors of Chagas disease (Hemiptera-Reduviidae).

The subfamily Triatominae (Hemiptera-Reduviidae) includes more than 150 blood-sucking species, potential vectors of the protozoan Trypanosoma cruzi, causative agent of Chagas disease. A distinctive cytogenetic characteristic of this group is the presence of extremely stable chromosome numbers. Unexpectedly, the analyses of the chromosomal location of ribosomal gene clusters and other repetitive sequences place Triatominae as a significantly diverse hemipteran subfamily. Here, we advance the understanding of Triatominae chromosomal evolution through the analysis of the 45S rDNA cluster chromosomal location in 92 Triatominae species. We found the 45S rDNA clusters in one to four loci per haploid genome with different chromosomal patterns: On one or two autosomes, on one, two or three sex chromosomes, on the X chromosome plus one to three autosomes. The movement of 45S rDNA clusters is discussed in an evolutionary context. Our results illustrate that rDNA mobility has been relatively common in the past and in recent evolutionary history of the group. The high frequency of rDNA patterns involving autosomes and sex chromosomes among closely related species could affect genetic recombination and the viability of hybrid populations, which suggests that the mobility of rDNA clusters could be a driver of species diversification.

La Salud Mental en Tiempos de la Pandemia / Mental Health in Times of Pandemic

Desde finales de diciembre con el comienzo de la pandemia en la pequeña municipalidad de Wahn en la China hasta hoy cuando más de 170 países se han visto afectados es poco lo que se ha considerado la salud mental de los más de siete mil millones de habitantes. La prioridad se ha centrado en el contexto de tratar de evitar la muerte de las personas infectadas a través de unidades de cuidados intensivos y agranactividad científica para la búsqueda de algún tratamiento efectivo o el descubrimiento de la vacuna.

From the end of December with the beginning of the pandemic in the small municipality of Wahn in China until today when more than 170 countries have been affected, little has been considered the mental health of the more than seven billion inhabitants. The priority has been centered in the context of trying to avoid the death of infected people through intensive care units and scientific activity in the search for an effective treatment or the discovery of the vaccine.

Inflammatory bowel disease is presenting sooner after immigration in more recent US immigrants from Cuba.

BACKGROUND: Despite a rising incidence of inflammatory bowel disease (IBD) in Hispanics in the United States, there are no studies examining the relationship between immigrant generation and IBD onset among Hispanics. AIMS: To determine whether age of IBD diagnosis, time from immigration to IBD diagnosis and IBD phenotype, differed across immigration periods in South Florida Cuban immigrants. METHODS: This was a cohort of consecutively identified Cuban-born adults who developed IBD in the United States and were followed in gastroenterology (GI) clinic. We divided time cohorts of immigration by historical relevance: before 1980, 1980-1994 and 1995-to-present. We examined differences across time cohorts in diagnosis age, time from immigration to IBD diagnosis, and IBD phenotype (ie, IBD type, disease location). RESULTS: A total of 130 Cuban patients with IBD were included. Age of IBD diagnosis was older in Cubans arriving before 1980 than in those arriving between 1980-1994 or after 1995 (44.7 vs 33.79 and 33.71, respectively, P<.0001). Time between immigration and diagnosis was shorter in patients arriving to the US after 1980 (31.77 years, Standard deviation (SD) 12.83 (<1980) vs 17.13 years, SD 8.55 (1980-1994) and 8.30 years, SD 4.72 (1995-to-present). IBD phenotype, including type of IBD, disease location and surgeries, did not differ significantly across time cohorts. CONCLUSIONS: Our study describes changing patterns of IBD onset following immigration in Cubans, suggesting that environmental changes either in the United States, Cuba or both are resulting in faster IBD onset in younger immigrant generations. These studies can inform the search for environmental triggers that may result in IBD.

Dental Decay Phenotype in Nonsyndromic Orofacial Clefting.

Although children with oral clefts have a higher risk for dental anomalies when compared with the general population, prior studies have shown conflicting results regarding their dental decay risk. Also, few studies have assessed dental decay risk in unaffected relatives of children with clefts. Thus, the question of increased risk of dental decay in individuals with oral clefts or their unaffected relatives is still open for empirical investigation. This study characterizes dental decay in the largest international cohort to date of children with nonsyndromic clefts and their relatives, as compared with controls, and it addresses whether families with oral clefts have a significantly increased risk for dental decay versus the general population. A total of 3,326 subjects were included: 639 case probands, 1,549 unaffected relatives, and 1,138 controls. Decay was identified from in-person dental examinations or intraoral photographs. Case-control differences were tested with regression analysis. No significant differences were shown in percentage decayed and filled teeth and decayed teeth in the primary dentition (dft, dt) and permanent dentition (DFT, DT) in cases versus controls. In the cleft region, no significant differences were seen in primary or permanent decay (dt, DT) when compared with controls. No difference was found with regard to cleft type and percentage dft, dt, DFT, and DT in case probands. Nonsignificant differences were found in unaffected siblings and parents versus controls (primary and permanent dentitions). Collectively, these findings indicate that individuals with nonsyndromic oral clefts and their families do not have a higher dental decay risk as compared with the general population. These results suggest that either genetic or environmental factors underlying a higher susceptibility for dental anomalies do not increase caries risk or that the seemingly higher risk for dental decay associated with increased dental anomalies in case probands may be superseded by possible greater access to dental care.

Tumor fibroso solitario de mama: aportación de la 18F-FDG PET/TC / Solitary fibrous breast tumour: Contribution of 18F-FDG PET/CT

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Papel pronóstico del volumen metabólico tumoral y de la glucólisis tumoral total en los estudios 18F-FDG PET/TC de estadificación del cáncer localmente avanzado de mama / Prognostic value of metabolic tumour volume and total lesion glycolysis in 18F-FDG PET/CT scans in locally advanced breast cancer staging

Objetivo. Conocer si el volumen metabólico tumoral (VMT) y la glucólisis tumoral total (GTT) pueden predecir el riesgo de recurrencia en cáncer localmente avanzado de mama (CLAM). Material y métodos. Estudio retrospectivo de pacientes con CLAM tratados con tratamiento neoadyuvante, local y adyuvante; en seguimiento. Se realizó una 18F-FDG PET/TC para estadificar la enfermedad, midiéndose diferentes parámetros metabólicos (VMT, GTT, SUVmáx y SUVmed), tanto en el tumor primario (T) como en los ganglios metastásicos (N) y en el cuerpo entero (CE). Resultados. Se incluyeron 40 mujeres entre enero de 2010-2011; seguimiento hasta enero de 2015. Con una mediana de seguimiento de 46 meses el 20% tuvieron recidiva, local (n=2) o a distancia (n=6); fallecieron 3 (38% de aquellas con recidiva y 7,5% del total). EL SUVmáx, VMT y GTT, tanto en T, como N y CE, fue mayor en aquellas que presentaron recidiva. En el T tanto el VMT como la GTT se relacionaron con la recidiva de la enfermedad (p=0,020 y p=0,028, respectivamente), mientras que en la N fue el SUVmáx (p=0,008). Los puntos de corte óptimos para predecir recurrencia fueron: VMT T≥19,3cm3, GTT T≥74,4g y SUVmáx N≥13,8, existiendo 10-12 veces más probabilidad de experimentar progresión tumoral cuando superaban estos umbrales. El grado tumoral fue la única variable clínico-patológica asociada con la recidiva (p=0,035). Conclusiones. En este estudio de CLAM los parámetros metabólicos que más se asocian con la tasa de recidiva son el VMT y la GTT en el tumor primario, el SUVmáx en la enfermedad ganglionar regional y los 3 índices PET en el cuerpo entero. Estos parámetros podrían utilizarse en la práctica asistencial para identificar a las pacientes con mayor riesgo (AU)

Objective. To determine whether metabolic tumour volume (MTV) and total lesion glycolysis (TLG) are able to predict recurrence risk in locally advanced breast cancer (LABC) patients. Material and methods. Retrospective study of LABC patients who undertook neoadjuvant, local and adjuvant treatment and follow up. A 18F-FDG PET/CT study for initial staging was performed analysing in this study different metabolic parameters (MTV, TLG, SUVmax and SUVmed) both in the primary tumour (T) as well as in axillary nodes (N) and whole-body (WB). Results. Forty females were included between January 2010-2011; follow up until January 2015 was completed. The average follow-up was 46 months. Twenty percent presented recurrence: local disease (n=2) and distant metastasis (n=6); 3 patients died (38% of the patients which recurred and 7.5% from the total). SUVmax, MTV and TLG, in T, N and WB, were higher in those patients with recurrence. The MTV and TLG parameters in the tumour (T) were related to the recurrence rate (P=.020 and P=.028, respectively); whereas SUVmax in the lymph nodes (N) was significantly related (P=.008) to the recurrence rate. The best cut-off points to predict recurrence where: MTV T ≥19.3cm3, TLG T≥74.4g and SUVmax N≥13.8, being 10-12 times more likely to recidivate when these thresholds where exceeded. Tumour grade was the only clinical-pathological variable which was related to recurrence probability (p=.035). Conclusions. In this study of LABC patients the metabolic parameters which have a better relationship with recurrence rate are: MTV and TLG in the primary tumour, SUVmax in the regional lymph node disease and whole-body PET data (AU)

La calidad de los psiquiatras en Colombia / Quality of Psychiatrists in Colombia

La calidad de la formación académica de los médicos es una preocupación mundial, de ella depende la calidad en la atención de la comunidad. En nuestro caso específico la de los médicos psiquiatras en Colombia. La percepción o imaginario colectivo es que de los 70.000 del país muchos de ellos no alcanzan estos lineamentos de excelencia, con el agravante de que durante años no reciben adecuados procesos de formación continua. Sin duda se hace necesario un proceso de certificación y recertificación a cada uno de los médicos responsables de la atención.

The quality of the academic training of physicians is a worldwide concern; the quality of care for the community depends on it. In our specific case, that of psychiatrists in Colombia. The perception or collective imagination is that of the 70,000 in the country, many of them do not reach these guidelines of excellence, with the aggravating factor that for years they do not receive adequate continuous training processes. Undoubtedly, a certification and recertification process for each of the physicians responsible for the care is necessary.

Prognostic value of metabolic tumour volume and total lesion glycolysis in 18F-FDG PET/CT scans in locally advanced breast cancer staging. / Papel pronóstico del volumen metabólico tumoral y de la glucólisis tumoral total en los estudios 18F-FDG PET/TC de estadificación del cáncer localmente avanzado de mama.

OBJECTIVE: To determine whether metabolic tumour volume (MTV) and total lesion glycolysis (TLG) are able to predict recurrence risk in locally advanced breast cancer (LABC) patients. MATERIAL AND METHODS: Retrospective study of LABC patients who undertook neoadjuvant, local and adjuvant treatment and follow up. A 18F-FDG PET/CT study for initial staging was performed analysing in this study different metabolic parameters (MTV, TLG, SUVmax and SUVmed) both in the primary tumour (T) as well as in axillary nodes (N) and whole-body (WB). RESULTS: Forty females were included between January 2010-2011; follow up until January 2015 was completed. The average follow-up was 46 months. Twenty percent presented recurrence: local disease (n=2) and distant metastasis (n=6); 3 patients died (38% of the patients which recurred and 7.5% from the total). SUVmax, MTV and TLG, in T, N and WB, were higher in those patients with recurrence. The MTV and TLG parameters in the tumour (T) were related to the recurrence rate (P=.020 and P=.028, respectively); whereas SUVmax in the lymph nodes (N) was significantly related (P=.008) to the recurrence rate. The best cut-off points to predict recurrence where: MTV T ≥19.3cm3, TLG T≥74.4g and SUVmax N≥13.8, being 10-12 times more likely to recidivate when these thresholds where exceeded. Tumour grade was the only clinical-pathological variable which was related to recurrence probability (p=.035). CONCLUSIONS: In this study of LABC patients the metabolic parameters which have a better relationship with recurrence rate are: MTV and TLG in the primary tumour, SUVmax in the regional lymph node disease and whole-body PET data.