Anomalous aortic origin of coronary artery biomechanical modeling: Toward clinical application.

OBJECTIVES: Anomalous aortic origin of the coronary artery can be associated with sudden cardiac death and ischemic events. Anatomic static characteristics mainly dictated surgical indications, although adverse events are usually related to dynamic physical effort. We developed a computational model able to simulate anomalous coronary behavior, and we aimed to assess its clinical applicability and to investigate coronary characteristics at increasing loading stress conditions. METHODS: We selected 5 patients with anomalous aortic origin of the coronary artery and 5 control subjects. For each of them, we construct a 3-dimensional model resembling the aortic root and coronary arteries based on 25 parameters obtained from computed tomography. Structural finite element analysis simulations were run to simulate pressure increasing in the aortic root during exercise (+40 mm Hg, +100 mm Hg with respect baseline condition, assumed at 80 mm Hg) and investigate coronary lumen characteristics. RESULTS: The 25 parameters were obtainable in all subjects with a consistent interobserver agreement. In control subjects, the right coronary artery had a more significant lumen expansion at loading conditions compared with anomalous aortic origin of coronary artery (6%-19.2% vs 1.8%-8.1%, P = .008), which also showed an inability to expand within the intramural segment. CONCLUSIONS: The proposed anomalous aortic origin of coronary artery model is able to represent the pathogenic disease mechanism after being populated with patient-specific data. It can assess the impaired expansion of anomalous right coronary at loading conditions, a process that cannot be quantified in any clinical set-up. This first clinical application showed promising results on quantifying pathological behavior, potentially helping in patient-specific risk stratification.

Análisis del hábito de hidratación y su conocimiento en una muestra escolares de 10-12 años en la provincia de Badajoz (España) / Analysis of the hydration habit and its knowledge in children sample from 10-12 years old in the province of Badajoz (Spain)

FUNDAMENTOS: Los actuales hábitos de vida empiezan a distanciarse cada vez más de aquellos que permiten mantener un estilo de vida saludable, destacando entre ellos el de la hidratación. Cada vez son más las personas que no se hidratan adecuadamente debido a la diversidad de bebidas refrescantes y al poco conocimiento que tienen sobre ellas y su importancia. Se destaca este hecho en la población infantil, debido principalmente a cómo se trabajan estos contenidos en las escuelas. Este trabajo pretende realizar un análisis del hábito de hidratación que presenta una muestra de escolares de dos colegios de la provincia de Badajoz (España), así como efectuar una prospección sobre los conocimientos que poseen a cerca de la importancia de la hidratación en el cuerpo humano. MÉTODOS: El diseño del estudio fue observacional transversal. Se utilizó para ello cuestionario validado para comprobar el nivel de consumo y conocimiento que posee una muestra de 168 escolares, en dos centros seleccionados en la provincial de Badajoz. RESULTADOS: Más de la mitad de los estudiantes (52,98%) no llegan a las recomendaciones de consumo de agua diario; no obstante mejorarían con la leche y los zumos naturales no envasados. Se destaca también el alto consumo de los refrescos ya que, alrededor de la mitad (48,21%) lo consumen por encima de las recomendaciones. Además, existen diferencias estadísticamente significativas (<0,05) entre sexos y lugar de residencia respecto a la frecuencia del consumo de agua. Por otro lado, únicamente sustancialmente menos de la mitad del alumnado investigado (24,40%) conocen la importancia de la hidratación. CONCLUSIONES: Los resultados obtenidos dejan claro que los participantes no poseen ni una hidratación realmente correcta ni un alto conocimiento sobre dicho tema. Se propone que sea incorporada esta temática, de la hidratación, a la Educación para la Salud escolar

BACKGROUND: The current habits of life begin to distance themselves more and more from those that allow maintaining a healthy lifestyle, highlighting among them that of hydration. More and more are people who do not hydrate properly, due to the diversity of refreshing drinks and the lack of knowledge that has the population about its importance. This fact stands out of the child population, mainly because of how they work content in schools. Therefore, this work is a research on the habit of hydration in children from two schools in the province of Badajoz, as well as make a research on the knowledge that possess about their importance in the human body. METHODS: The design study was transversal observational. We conducted a validating questionnaire to check the level of consumption and knowledge that have a total of 168 school divided into two centers of the region of Badajoz. RESULTS: More than half of the students (52.98%) fail the recommendations of daily water consumption; however, they get better with milk and natural juices. The high consumption of soft drinks also stands out, since around half (48.21%) consume it above the recommendations. On the other hand, just much less than half of them (24.40%) know the importance of hydration. Also there are statistical differences (<0.05) between sex and location of the region with respect to the water ingest. CONCLUSIONS: The results make clear that the participants do not possess a really correct hydration or a high knowledge on this subject. In addition, there are differences between sexes and places of residence in certain sections. So it's suggest that this subject be incorporated into the school health education

Modelo predictivo de metástasis en ganglios axilares no centinela en cáncer de mama. Variables emergentes. Estudio MOTTO, parte I / Predictive model of breast cancer metastasis in axillary non-sentinel lymph nodes. Emergent variables. The MOTTO study, part I

INTRODUCCIÓN: La carga tumoral total (CTT) obtenida del estudio OSNA de cada uno de los ganglios centinela ha sido identificada como el predictor más potente de metástasis en ganglios linfáticos axilares no centinela. Por otra parte, los distintos subtipos moleculares (SM) de cáncer de mama difieren entre ellos de forma significativa no solo en términos de incidencia, pronóstico y tratamiento, sino también respecto al patrón de afectación metastásica axilar. Nuestra hipótesis consiste en que la predicción de enfermedad metastásica en la linfadenectomía axilar puede mejorar aplicando un modelo predictivo basado en la CTT y el subtipo intrínseco del tumor. OBJETIVO: Evaluar el impacto del SM subrogado inmunohistoquímicamente en la predicción metastásica de los ganglios axilares no centinela con base en la CTT. MATERIAL Y MÉTODOS: Estudio retrospectivo, multicéntrico europeo, que incluye 683 pacientes procedentes de 9 hospitales. RESULTADOS: El análisis univariante identificó 6 variables independientes que correlacionan significativamente con la afectación metastásica axilar no centinela. De ellas, las variables valor logarítmico de la CTT, diámetro tumoral y SM diagnosticado por inmunohistoquímica fueron seleccionadas para el modelo multivariante. Las odds ratio estimadas por el modelo fueron valor logarítmico de la CTT 1.527 (IC 95% 1.299-1.796), diámetro tumoral 1.503 (IC 95% 1.062-2.129) y SM 2.195 (IC 95% 1.246-3.867). CONCLUSIONES: El SM, la CTT y el diámetro tumoral son los predictores más potentes de afectación axilar y deben ser incluidos en los algoritmos diagnósticos como variables esenciales para la toma de decisiones terapéuticas sobre la axila

INTRODUCTION: The total tumour load (TTL) obtained from OSNA study in each of the sentinel lymph nodes has been identified as the most powerful predictor of axillary non-sentinel lymph node metastasis. In addition, the distinct molecular subtypes (MS) of breast cancer differ significantly not only in terms of incidence, prognosis and treatment but also in terms of the pattern of axillary metastatic involvement. We hypothesised that the prediction of metastatic disease in axillary lymphadenectomy could be enhanced by applying a predictive model based on the TTL and the intrinsic tumour subtype. OBJECTIVE: To evaluate the impact of the MS identified by immunohistochemistry on prediction of metastatic disease in axillary non-sentinel lymph nodes based on TTL. MATERIAL AND METHODS: Retrospective, European multicenter study including 683 patients from 9 hospitals. RESULTS: Univariate analysis identified 6 variables that were significantly correlated with axillary non-sentinel metastasis. Of these, the variables logarithmic value of the TTL, tumour diameter and MS diagnosed by immunohistochemistry were selected for multivariate analysis. The odds ratio estimated by the model were: logarithmic value of the TTL 1.527 (95% CI: 1.299-1.796), tumour diameter 1.503 (95% CI: 1.062-2.129) and MS 2.195 (95% CI: 1.246-3.867). CONCLUSIONS: The strongest predictors of axillary involvement were MS, TTL and tumour diameter. These variables should be included in diagnostic algorithms as essential parameters for therapeutic decision-making on the axilla

Correlation between measures of perceptual assessment of GRB and contact quotient (CQ). / Correlación entre medidas de evaluación perceptual GRB y cociente de contacto.

OBJECTIVE: The aim of the present workis to correlate the perceptual parameters grade, roughness and breathiness of the GRB scale with the contact quotient (CQ) obtained by electroglotography. MATERIAL AND METHOD: 70 samples of normal and pathological voices were analyzed by means of auditory-perceptual analysis and electroglotography. The perceptual analysis was carried out by two expert judges depending on the parameters grade, roughness and breathiness. The CQ values were obtained through the VoceVista System Version 3.3.7. RESULTS: The results show a strong correlation between CQ and breathiness (r = -0.869), whereas between grade of dysphonia and CQ (r = -0.567), and roughness and CQ (r = 0.643) the correlation is average. CONCLUSIONS: It is possible to establish relationships between the vibrational behavior of the vocal folds and the resulting phenomenon that we perceive auditively. The most relevant parameter in this respect was breathiness. The correlation between grade, roughness and CQ was weaker.

Evaluación funcional de la etapa faríngea de la deglución utilizando sonar Doppler. Revisión crítica de la literatura / Functional assessment of pharyngeal phase of swallowing with sonar Doppler. Critic revision of the literature

El sonar Doppler es una herramienta que permite captar lo que sucede durante la etapa faríngea de la deglución, siendo el sonido percibido y observado un reflejo parcial de la actividad motora que se desencadena. El presente trabajo indaga acerca de las posibilidades del sonar Doppler y su aplicación en la evaluación funcional de la deglución. Se desarrolla un diseño de investigación observacional y retrospectivo, bajo la metodología de revisión sistemática a partir de material bibliográfico, investigaciones y publicaciones de artículos de revistas en inglés, portugués y español, consultando las bases de datos PubMed, SciELO, EBSCO Host, Scopus, Springer, Cochrane, además de revistas especializadas en ASHA, MedLine, CEFAC y Redalyc. Aunque la fiabilidad y validez en el uso del sonar Doppler para la evaluación funcional de la etapa faríngea de la deglución no están aseguradas, podría llegar a brindar enorme ayuda en el diagnóstico de las aspiraciones y/o penetraciones durante el proceso deglutorio. Se insiste en una constante revisión de la metodología para la detección correcta de los sonidos de la deglución y su posterior análisis e interpretación clínica (AU)

Sonar Doppler is a tool that can capture what happens during the pharyngeal stage of swallowing, being the sound perceived and the noting a partial reflection of the motor activity that is triggered. This paper focuses on the possibilities of sonar Doppler and its application in functional assessment of swallowing. The design of this research is retrospective and observational, developed under the systematic review methodology, from bibliographical material, pieces of research and publications of journal articles in English, Portuguese and Spanish, taking the databases of PubMed, SciELO, EBSCO Host, Scopus, Springer, Cochrane, besides specialized magazines in ASHA, MedLine, CEFAC and Redalyc. Although the reliability and validity in the use of sonar Doppler for the functional evaluation of the pharyngeal stage of swallowing are uncertain, it could provide enormous help in diagnosing aspirations and/or penetrations during the swallowing process. We insist on a constant review of the methodology for the correct detection of sounds of swallowing and subsequent analysis and clinical interpretation (AU)

Efectividad de los abordajes terapéuticos aplicados en docentes con alteraciones vocales funcionales / Therapeutic effectiveness of approaches applied in teachers with functional vocal disorders

El presente trabajo constituye una revisión bibliográfica acerca de la efectividad de la terapia/entrenamiento funcional aplicada a docentes con alteraciones vocales funcionales. Se desarrolla un diseño de investigación observacional y retrospectivo, bajo la metodología de revisión sistemática, a partir de publicaciones de revistas en las bases de datos PubMed, SciELO, Scopus y Cochrane, así como en revistas especializadas como la de la American SpeechLanguage-Hearing Association (ASHA), Journal of Voice, CEFAC y Redalyc. La revisión del material evidencia resultados positivos para los distintos abordajes abarcados. En diversas proporciones, cada uno contribuye a mejorar la calidad vocal, sostener el equilibrio entre los componentes que construyen la emisión y prolongar la armonía que debe sustentar la voz.

This paper constitutes a bibliographic review on the effectiveness of therapeutic/training approaches applied in teachers with vocal alterations. Research has been designed in a retrospective and observational way, with a systemic review methodology based on publications from papers indexed in PubMed, SciELO, Scopus and Cochrane databases, as well as specialized journals such as American Speech-Language-Hearing Association (ASHA), Journal of Voice, CEFAC and Redalyc. The review of the material showed positive results for the different approaches. In varying proportions each one contributes to improve voice quality, hold the balance between the components that build the emission and prolong the harmony which should sustain the voice.

Modelo predictivo multiparamétrico del estatus axilar en pacientes con cáncer de mama: carga tumoral total y perfil molecular. Estudio multicéntrico / A multiparametric predictive model of axillary status in patients with breast cancer: total tumoral load and molecular signature. A multicenter study

Objetivo. El objetivo de nuestro estudio es evaluar el impacto combinado de cada uno de los perfiles moleculares del cáncer de mama, subrogados inmunohistoquímicamente junto con la carga tumoral total del ganglio centinela como predictores de afectación metastásica en los ganglios axilares no centinela. Material y métodos. Se incluyeron 373 pacientes de carcinoma infiltrante de mama con ganglio centinela metastásico y linfadenectomía axilar, procedentes de seis hospitales españoles. Se aplicaron los criterios de ST Gallen para definir el perfil molecular. Se realizó un análisis multivariante para definir diferentes modelos predictivos y se estudiaron las distribuciones de densidad de probabilidad de la carga tumoral para cada perfil molecular en los casos con axila metastásica y no metastásica en los ganglios no centinela. Resultados. Hubo un 66% de linfadenectomías axilares metastásicas. Se obtuvieron 7 modelos predictivos cuyas áreas bajo la curva ROC oscilaron entre 0,65 y 0,77. El mejor modelo fue el basado en la carga tumoral total, tipo histológico, diámetro tumoral, grado, invasión linfovascular, perfil molecular y número total de ganglios centinela. Las mayores diferencias de densidad de probabilidad de la carga tumoral total se producen entre las distribuciones de casos positivos y negativos de los perfiles moleculares BH, TN y HER2. Conclusión. La inclusión del perfil molecular en el modelo mejora el área bajo la curva ROC, especialmente si se incluye también el número total de cganglios centinela. Se observan diferencias entre los distintos perfiles moleculares para el valor predictivo de la carga tumoral total (AU)

Objective. To evaluate the combined impact of each of the immunohistochemically surrogated molecular signatures (PM) of breast cancer subtype along with the total tumor load (CTT) of the sentinel node (SN) as a predictor of non-SN metastatic involvement. Methods. We included 373 patients diagnosed with infiltrating breast cancer with metastatic SN who underwent subsequent axillary lymph node dissection (ALND) from six hospitals. The surrogate MS for each case was defined as per ST Gallen definitions. A multivariate analysis was conducted to estimate the predictive model and normal kernel functions to fit the density distributions of the total tumoral load for each molecular signatures. Results. Metastatic involvement of the axillary lymph node was identified in 66% of the patients. We obtained seven different predictive models with an area under curve (AUC) ranging from 0.65 to 0.77. The best model was based on the CTT, histological type, tumor size, stage, lymphatic invasion, MS, and the total number of SN. The greatest differences in the density functions of the CTT were found in the PM for positive and negative cases of the BH, TN and HER2 subtypes. Conclusions. The inclusion of PM in the multivariate model improved the AUC, especially when the total number of sentinel nodes were included. Differences were observed in the impact of the CTT among the different smolecular profiles subtypes (AU)

Computational analysis of KRAS mutations: implications for different effects on the KRAS p.G12D and p.G13D mutations.

BACKGROUND: The issue of whether patients diagnosed with metastatic colorectal cancer who harbor KRAS codon 13 mutations could benefit from the addition of anti-epidermal growth factor receptor therapy remains under debate. The aim of the current study was to perform computational analysis to investigate the structural implications of the underlying mutations caused by c.38G>A (p.G13D) on protein conformation. METHODS: Molecular dynamics (MD) simulations were performed to understand the plausible structural and dynamical implications caused by c.35G>A (p.G12D) and c.38G>A (p.G13D). The potential of mean force (PMF) simulations were carried out to determine the free energy profiles of the binding processes of GTP interacting with wild-type (WT) KRAS and its mutants (MT). RESULTS: Using MD simulations, we observed that the root mean square deviation (RMSD) increased as a function of time for the MT c.35G>A (p.G12D) and MT c.38G>A (p.G13D) when compared with the WT. We also observed that the GTP-binding pocket in the c.35G>A (p.G12D) mutant is more open than that of the WT and the c.38G>A (p.G13D) proteins. Intriguingly, the analysis of atomic fluctuations and free energy profiles revealed that the mutation of c.35G>A (p.G12D) may induce additional fluctuations in the sensitive sites (P-loop, switch I and II regions). Such fluctuations may promote instability in these protein regions and hamper GTP binding. CONCLUSIONS: Taken together with the results obtained from MD and PMF simulations, the present findings implicate fluctuations at the sensitive sites (P-loop, switch I and II regions). Our findings revealed that KRAS mutations in codon 13 have similar behavior as KRAS WT. To gain a better insight into why patients with metastatic colorectal cancer (mCRC) and the KRAS c.38G>A (p.G13D) mutation appear to benefit from anti-EGFR therapy, the role of the KRAS c.38G>A (p.G13D) mutation in mCRC needs to be further investigated.

KRAS, BRAF, EGFR and HER2 gene status in a Spanish population of colorectal cancer.

To evaluate the KRAS, BRAF, EGFR, and HER2 gene status in colorectal cancer by novel techniques and evaluate whether anti-HER2 therapies could be offered in the treatment of these patients. There are conflicting data on the prevalence of BRAF mutations and EGFR and HER2 gene amplification in colorectal KRAS wild type patients. In our study we tried to evaluate these expressions and their relationship to future treatment assays. Clinical-pathological data and paraffin-embedded specimens were collected from 186 patients who underwent colorectal resections at General Yagüe Hospital in Burgos, Spain. KRAS and BRAF status was analyzed by real-time PCR in all patients. EGFR and HER2/NEU gene amplification was detected using fluorescent in situ hybridisation technique (FISH) in 38 KRAS and BRAF wild type patients. KRAS mutations were present in 48% of the colorectal cancer patients. BRAF mutations were present in 6.25% of the KRAS wild type patients. EGFR and HER2 gene amplification was observed in 5.3% and 26.3%, respectively, of KRAS and BRAF wild type colorectal cancer patients. HER2, but not EGFR gene amplification, was frequently observed in KRAS and BRAF wild type colorectal cancer patients. These data indicate that HER2 amplification could be one of the genes to be considered in the therapeutic management of colorectal cancer.