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1.
Histol Histopathol ; : 18200, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31951010

RESUMO

Many surgical techniques are employed in the treatment of severe obesity. A main consequence of these techniques is the improvement of type 2 Diabetes mellitus. Ghrelin is a gut hormone released in the gastric fundus and corpus, which has been related to diabetic improvement as mentioned in these papers. Sleeve gastrectomy and Roux-en Y Gastric Bypass are surgical techniques broadly employed in humans; both severely reduce the gastric surface. Paradoxically, the serum level of ghrelin in patients is preserved. We hypothesized about the role of embryonic pancreatic epsilon cells, which have the capacity to release ghrelin. We studied the changes in the epsilon cells and differentiation markers with immunostaining and ghrelin serum level and after surgery. We employed euglycemic male Wistar rats: two surgical groups (Sleeve gastrectomy and Roux-en Y Gastric Bypass) and two control groups. We reported a significant increase of ghrelin epsilon-cells in the pancreas and basal serum after Sleeve gastrectomy versus the control groups. The epsilon cellular increment was related to neogenesis, as the neurogenin-3 marker revealed. The Roux-en Y Gastric Bypass showed neither epsilon cell increase nor basal serum changes in ghrelin release. As a conclusion, we reported that the severe suppression of the fundus gastric produced the recovery of ghrelin released by the epsilon cells, which was indicative of an ontogenic embryonic pancreatic function.

2.
Mol Nutr Food Res ; : e1900616, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31953983

RESUMO

SCOPE: The objective of this study was to determine the cardiovascular effects of the probiotics Bifidobacterium breve CECT7263 (BFM) and Lactobacillus fermentum CECT5716 (LC40), and the short chain fatty acids butyrate and acetate in spontaneously hypertensive rats (SHR). METHODS AND RESULTS: Ten five-weeks old Wistar Kyoto rats (WKY) and fifty aged-matched SHR were randomly distributed into six groups: control WKY, control SHR, treated SHR-LC40, treated SHR-BMF, treated SHR-butyrate, and treated SHR-acetate. Chronic treatments with LC40 or BFM increased butyrate-producing bacteria and prevented the blood pressure increase in SHR. Oral treatment with butyrate or acetate also prevented the increase in both blood pressure and Firmicutes/Bacteroidetes ratio. All treatments restored the Th17/Treg balance in mesenteric lymph nodes, normalized endotoxemia, and prevented the impairment of endothelium-dependent relaxation to acetylcholine, as a result of reduced NADPH oxidase-driven reactive oxygen species production. These protective effects might be mediated by both the reduction in vascular lipopolysaccharide/toll-like receptor 4 pathway and the increase in Treg infiltration in the vasculature. CONCLUSION: The probiotics LC40 and BFM prevent dysbiosis and the development of endothelial dysfunction and high blood pressure in genetic hypertension. These effects seems to be related to endotoxemia reduction and to increase Treg accumulation in the vasculature. This article is protected by copyright. All rights reserved.

4.
Exp Parasitol ; : 107830, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31917970

RESUMO

Chagas disease, also known as American trypanosomiasis, is a potentially life-threatening illness caused by the protozoan parasite Trypanosoma cruzi, which is transmitted by insects of the family Reduviidae. Since conventional treatments with nitroheterocyclic drugs show serious adverse reactions and have questionable efficiency, different research groups have investigated polypeptide-based approaches to interfere with the parasite cell cycle in other Trypanosomatids. These strategies are supported by the fact that surface players are candidates to develop surface ligands that impair function since they may act as virulence factors. In this study, we used a phage display approach to identify peptides from one library-LX8CX8 (17 aa) (where X corresponds to any amino acid). After testing different biopanning conditions using live or fixed epimastigotes, 10 clones were sequenced that encoded the same peptide, named here as EPI18. The bacteriophage expressing EPI18 binds to epimastigotes from distinct strains of T. cruzi. To confirm these results, this peptide was synthetized, biotinylated, and assayed using flow cytometry and confocal microscopy analyses. These assays confirmed the specificity of the binding capacity of EPI18 toward epimastigote surfaces. Our findings suggest that EPI18 may have potential biotechnological applications that include peptide-based strategies to control parasite transmission.

5.
Artigo em Inglês | MEDLINE | ID: mdl-31919634

RESUMO

OBJECTIVE: To compare detectability of hyperfunctioning parathyroid tissue (HPT) by digital and analog 18F-fluorocholine PET/CT in patients with primary hyperparathyroidism and negative/inconclusive 99mTc-MIBI scintigraphy-SPECT/CT. MATERIALS AND METHODS: Thirty-three patients with primary hyperparathyroidism and negative/inconclusive 99mTc-MIBI scintigraphy-SPECT/CT were prospectively included. All patients accepted to be scanned by digital and analog PET/CT in the same imaging session after a single injection of 18F-fluorocholine. Three nuclear medicine physicians evaluated the digital and analog PET/CT datasets to assess the detection rate of HPT. Maximum standard uptake values (SUVmax) of HPT and locoregional lymph nodes were measured in both systems. RESULTS: HPT was detected in 30/33 patients by the digital system, whereas it was detected in 22/33 patients by the analog system (p < 0.01). Moreover, in 21 of these 33 patients, both systems detected one focal 18F-fluorocholine uptake, and in one patient the digital system detected two foci. Histopathology demonstrated HPT in 32 patients and it was inconclusive in one patient. The digital PET/CT detected HPT in 29 of the 32 patients, and the analog system in 22 of the 32 (p < 0.01). All HPT suspected lesions resected and detected only by the digital system (n = 8) were < 10 mm (7.5 ± 1.3 mm), while those detected by both systems (n = 22) were > 10 mm (13 ± 3.8 mm). SUVmax of HPT lesions was significantly higher than SUVmax of locoregional lymph node independently of the PET/CT system used (4.5 ± 1.9 vs. 2.9 ± 1.3, p < 0.0001). CONCLUSIONS: Digital PET/CT offers superior performance over analog system in patients with suspected HPT and previous negative/inconclusive imaging examinations, particularly in sub-centimeter lesions. SUVmax can help in the differentiation between HTP and locoregional lymph nodes.

6.
Nat Commun ; 11(1): 114, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31913286

RESUMO

Stem cell therapies are limited by poor cell survival and engraftment. A hurdle to the use of materials for cell delivery is the lack of understanding of material properties that govern transplanted stem cell functionality. Here, we show that synthetic hydrogels presenting integrin-specific peptides enhance the survival, persistence, and osteo-reparative functions of human bone marrow-derived mesenchymal stem cells (hMSCs) transplanted in murine bone defects. Integrin-specific hydrogels regulate hMSC adhesion, paracrine signaling, and osteoblastic differentiation in vitro. Hydrogels presenting GFOGER, a peptide targeting α2ß1 integrin, prolong hMSC survival and engraftment in a segmental bone defect and result in improved bone repair compared to other peptides. Integrin-specific hydrogels have diverse pleiotropic effects on hMSC reparative activities, modulating in vitro cytokine secretion and in vivo gene expression for effectors associated with inflammation, vascularization, and bone formation. These results demonstrate that integrin-specific hydrogels improve tissue healing by directing hMSC survival, engraftment, and reparative activities.

7.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31926931

RESUMO

INTRODUCTION: Thyroid nodule (TN) is a common reason for consultation in daily practice. The purpose of this study was to evaluate the diagnosis and treatment of TNs in our environment and to assess the current status regarding the existence and structure of high-resolution TN clinics. MATERIAL AND METHODS: Members of the Spanish Society of Endocrinology and Nutrition were invited in 2018 to participate in an online survey on the diagnostic and therapeutic processes of TN. RESULTS: A total of 211 valid surveys were received. Of all respondents, 30.8% stated that there were high-resolution TN clinics in their environment, with the endocrinologist being the main person responsible for performing ultrasonography (87.7%) and fine needle aspiration (FNA) (69.2%). For ultrasound classification of TNs, 32.7% used the ATA criteria, 32.2% the TI-RADS criteria, and 22.7% no classification. In situ verification of sample suitability was performed in 35.5% of the cases, and molecular analysis in 8.1%. With regard to clinical discharge, 65.4% would consider it after 5 years of follow-up and with a benign FNA. In the event of a Bethesda III result, 50.2% of respondents would repeat FNA and 35.5% would opt for surgery; if a Bethesda IV result was found, 95.8% would opt for surgery. CONCLUSIONS: High-resolution TN clinics are structures increasingly implemented in our environment where the endocrinologist is the main person responsible for performing ultrasonography and FNA. The standard clinical practice in our specialty is consistent with most recommendations concerning clinical practice guidelines for TNs.

8.
Aten Primaria ; 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31932015

RESUMO

OBJECTIVES: This study is aimed at analyzing the impact of the main factors contributing to short and long-term mortality in patients at final stages of heart failure (HF). SETTING: Patients attended at any of the 279 primary health care centers belonging to the Institut Català de la Salut, in Catalonia (Spain). PARTICIPANTS: Patients with Advanced HF. DESIGN: Multicenter cohort study including 1148 HF patients followed for one-year after reaching New York Heart Association (NYHA) IV. MAIN MEASUREMENTS: The primary outcome was all-cause mortality. Multivariate logistic regression models were performed to assess the outcomes at 1, 3, 6, and 12 months. RESULTS: Mean age of patients was 82 (SD 9) years and women represented 61.7%. A total of 135 (11.8%) and 397 (34.6%) patients died three months and one year after inclusion, respectively. Male gender, age, and decreased body mass index were associated with higher mortality at three, six and twelve months. In addition, low systolic blood pressure levels, severe reduction in glomerular filtration, malignancy, and higher doses of loop diuretics were related to higher mortality from 6 to 12 months. The most important risk factor over the whole period was presenting a body mass index lower than 20kg/m2 (three months OR 3.06, 95% CI: 1.58-5.92; six months OR 4.42, 95% CI: 2.08-9.38; and 12 months OR 3.68, 95% CI: 1.76-7.69). CONCLUSIONS: We may conclude that male, age, and decreased body mass index determined higher short-term mortality in NYHA IV. In addition, low systolic blood pressure, reduced glomerular filtration, malignancy, and higher doses of loop diuretics contribute to increasing the risk of mortality at medium and long-term. Such variables are easily measurable and can help to decide the best way to face the most advances stages of the disease.

11.
Nat Mater ; 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31907417

RESUMO

Spin-orbit coupling stands as a powerful tool to interconvert charge and spin currents and to manipulate the magnetization of magnetic materials through spin-torque phenomena. However, despite the diversity of existing bulk materials and the recent advent of interfacial and low-dimensional effects, control of this interconversion at room temperature remains elusive. Here, we demonstrate strongly enhanced room-temperature spin-to-charge interconversion in graphene driven by the proximity of WS2. By performing spin precession experiments in appropriately designed Hall bars, we separate the contributions of the spin Hall and the spin galvanic effects. Remarkably, their corresponding conversion efficiencies can be tailored by electrostatic gating in magnitude and sign, peaking near the charge neutrality point with an equivalent magnitude that is comparable to the largest efficiencies reported to date. Such electric-field tunability provides a building block for spin generation free from magnetic materials and for ultra-compact magnetic memory technologies.

12.
Int J Med Inform ; 135: 104053, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31884312

RESUMO

OBJECTIVE: Early identification and treatment of patient deterioration is crucial to improving clinical outcomes. To act, hospital rapid response (RR) teams often rely on nurses' clinical judgement typically documented narratively in the electronic health record (EHR). We developed a data-driven, unsupervised method to discover potential risk factors of RR events from nursing notes. METHODS: We applied multiple natural language processing methods, including language modelling, word embeddings, and two phrase mining methods (TextRank and NC-Value), to identify quality phrases that represent clinical entities from unannotated nursing notes. TextRank was used to determine the important word-sequences in each note. NC-Value was then used to globally rank the locally-important sequences across the whole corpus. We evaluated our method both on its accuracy compared to human judgement and on the ability of the mined phrases to predict a clinical outcome, RR event hazard. RESULTS: When applied to 61,740 hospital encounters with 1,067 RR events and 778,955 notes, our method achieved an average precision of 0.590 to 0.764 (when excluding numeric tokens). Time-dependent covariates Cox model using the phrases achieved a concordance index of 0.739. Clustering the phrases revealed clinical concepts significantly associated with RR event hazard. DISCUSSION: Our findings demonstrate that our minimal-annotation, unsurprised method can rapidly mine quality phrases from a large amount of nursing notes, and these identified phrases are useful for downstream tasks, such as clinical outcome predication and risk factor identification.

13.
Int J Med Inform ; 133: 104016, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31707264

RESUMO

OBJECTIVES: Nurse concerns documented in nursing notes are important predictors of patient risk of deterioration. Using a standard nursing terminology and inputs from subject-matter experts (SMEs), we aimed to identify and define nurse concern concepts and terms about patient deterioration, which can be used to support subsequent automated tasks, such as natural language processing and risk predication. METHODS: Group consensus meetings with nurse SMEs were held to identify nursing concerns by grading Clinical Care Classification (CCC) system concepts based on clinical knowledge. Next, a fundamental lexicon was built placing selected CCC concepts into a framework of entities and seed terms to extend CCC granularity. RESULTS: A total of 29 CCC concepts were selected as reflecting nurse concerns. From these, 111 entities and 586 seed terms were generated into a fundamental lexicon. Nursing concern concepts differed across settings (intensive care units versus non-intensive care units) and unit types (medicine versus surgery units). CONCLUSIONS: The CCC concepts were useful for representing nursing concern as they encompass a nursing-centric conceptual framework and are practical in lexicon construction. It enabled the codification of nursing concerns for deteriorating patients at a standardized conceptual level. The boundary of selected CCC concepts and lexicons were determined by the SMEs. The fundamental lexicon offers more granular terms that can be identified and processed in an automated fashion.

14.
Rev Esp Enferm Dig ; 112(1): 64-70, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31880160

RESUMO

BACKGROUND: hepatitis C, besides health impairment, results in significant loss of productivity and diminished quality of life, and noticeably contributes to health expenditure increases. Because of all this, the Spanish Ministry of Health (Ministerio de Sanidad, Consumo y Bienestar Social - MSCBS) implemented in 2015 a strategic plan for managing hepatitis C (Plan Estratégico para el Abordaje de la Hepatitis C - PEAHC) within the National Health System. However, the PEAHC includes no screening plan. The MSCBS developed a framework document on population screening (Documento Marco sobre Cribado Poblacional) that defines the criteria a disease must meet in order to consider implementing a screening program. Specifically, it defines 4 criteria related to the health issue, 4 related to the screening test, and 3 criteria dealing with diagnosis confirmation and treatment. OBJECTIVE: to identify whether there is scientific evidence to support hepatitis C meeting the criteria to be considered a disease qualifying for a population screening strategy in Spain. METHODS: a literature search for scientific evidence concerning each required criterion for implementing a population screening plan for hepatitis C in Spain. RESULTS: sufficient scientific evidence was found to support hepatitis C meeting the criteria required by the MSCBS for the implementation of a population screening program. CONCLUSIONS: according to the available scientific evidence, hepatitis C in Spain meets the required criteria to qualify for consideration of population screening plan.

15.
Minerva Anestesiol ; 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31808662

RESUMO

BACKGROUND: Postoperative pulmonary complications (PPCs) negatively affect morbidity, healthcare costs and postsurgical survival. Preoperative and intraoperative peripheral oxyhemoglobin saturation (SpO2) levels are independent risk factors for postoperative pulmonary complications (PPCs). The airtest assesses the value of SpO2 while breathing room air. We aimed at building a clinical score that includes the airtest for predicting the risk for PPCs. METHODS: This is a development and validation study in patients randomly divided into two cohorts from a large randomized clinical trial (iPROVE) that enrolled 964 intermediatetohigh risk patients scheduled for abdominal surgery. Arterial oxygenation was assessed on roomair in the preoperative period (preoperative airtest) and 3h after admission to the postoperative care unit (postoperative airtest). The airtest was defined as positive or negative if SpO2 was ≤96% or >96%, respectively. Positive airtests were stratified into weak (9396%) or strong (<93%). The primary outcome was a composite of moderatetosevere PPCs during the first seven post operative days. RESULTS: A total of 902 patients were included in the final analysis (542 in the development cohort and 360 in the validation cohort). Regression analysis identified five independent risk factors for PPC: age, type of surgery, pre and postoperative airtest, and atelectasis. The area under the receiver operating characteristic curve (AUC) was 0.79 (95% CI: 0.750.82) when including this five independent predictors. We built a simplified score termed "airtest score" by using only the pre and postoperative SpO2, resulting in an AUC of 0.72 (95% CI: 0.670.76) for the derivation and 0.72 (95% CI :0.660.78) for the validation cohort, respectively. The air test score stratified patients into four levels of risk, with PPCs ranging from <15% to >75%. CONCLUSIONS: The simple, noninvasive and inexpensive bedside airtest score, evaluating pre and postoperatively SpO2 measured on roomair, helps to predict the risk for PPCs.

16.
Artigo em Inglês | MEDLINE | ID: mdl-31816966

RESUMO

Mental health problems have been identified by the World Health Organization as a global development priority. Negative attitudes toward mental health patients have been documented in multiple health professionals. The aim of this study was to determine the level of stigma and associated factors toward people with mental health problems among students doing their degree in nursing. An explanatory sequential mixed-methods approach. A cross-sectional descriptive observational study was carried out on a sample of 359 students doing their degree in nursing. Students had to be enrolled in any of the four years of study of the degree at the time the questionnaire was done. We explored the perception and experience of students doing their degree in nursing regarding the level of stigma, through in-depth interviews (n = 30). The mean overall Mental Health Stigma Scale (MHSS) score was 30.7 points (SD = 4.52); 29.5% (n = 106) scored low for stigma, 49.9% (n = 179) showed moderate stigma, and 20.6% (n = 74) scored high. The multivariate analysis showed that 4th-year students had an OR of 0.41 (CI95%: 0.20-0.84) for high/moderate stigma and that 3rd-year students had an OR of 0.49 for high/moderate stigma compared with 1st-year students. We also observed that students with family members with mental health problems had an OR of 2.05 (CI95%: 1.19-3.56) for high/moderate stigma compared with students who did not have family members with mental health problems. The following categories emerged: fear and lack of knowledge, breaking the silence, and integration into society. The levels of mental health stigma in our sample of nursing students were moderate. Stigma levels were lower in 3rd- and 4th-year students (i.e., after having received training in mental health), and in students with family members with mental health problems.

17.
J Clin Med ; 8(12)2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31818026

RESUMO

INTRODUCTION: Thyroid nodules are a common finding. A high-resolution thyroid nodule clinic (HR-TNC) condenses all tests required for the evaluation of thyroid nodules into a single appointment. We aimed to evaluate the clinical outcomes at HR-TNCs. DESIGN AND METHODS: A retrospective cross-sectional multicenter study including data from four HR-TNCs in Spain. We evaluated fine-needle aspiration (FNA) indications and the association between clinical and ultrasound characteristics with cytological and histopathological outcomes. RESULTS: A total of 2809 thyroid nodules were included; FNA was performed in 82.1%. Thyroid nodules that underwent FNA were more likely larger, isoechoic, with microcalcifications, and in younger subjects. The rate of nondiagnostic FNA was 4.3%. A solid component, irregular margins or microcalcifications, significantly increased the odds of Bethesda IV-V-VI (vs. Bethesda II). Irregular margins and a solid component were independently associated with increased odds of malignancy. Thyroid nodules <20 mm and ≥20-<40 mm had a 6.5-fold and 3.3-fold increased risk for malignancy respectively in comparison with those ≥40 mm. CONCLUSION: In this large multicenter study, we found that the presence of a solid component and irregular margins are factors independently related to malignancy in thyroid nodules. Since nodule size ≥40 mm was associated with the lowest odds of malignancy, this cut-off should not be a factor leading to indicate thyroid surgery. HR-TNCs were associated with a low rate of nondiagnostic FNA.

18.
Front Microbiol ; 10: 2561, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31787953

RESUMO

The complete genome of the strain Labrenzia sp. PHM005, a free-living producer of a pederin analog 18-O-demethyl pederin, hereinafter labrenzin, has been sequenced. This strain contains two replicons comprising a circular chromosome of 6,167,349 bp and a circular plasmid (named p1BIR) of 19,450 bp. A putative gene cluster responsible for the synthesis of labrenzin (lab cluster) has been identified showing that it encodes a trans-AT mixed type PKS/NRPS biosynthetic pathway that is responsible for the synthesis of pederin and possibly an onnamide analog. The putative boundaries of the lab gene cluster were determined by genetic comparisons with other related strains, suggesting that the cluster consists of a 79-kb region comprising 3 genes encoding multidomain hybrid polyketide synthase/non-ribosomal peptide synthetase (PKS/NRPS) proteins (PKS4, PKS/NRPS13, and PKS/NRPS15), and 16 auxiliary enzymes. Transcriptomic analyses suggest that all the genes of the cluster are expressed in our culture conditions (i.e., in minimal medium in the absence of any specific inducer) at detectable levels. We have developed genetic tools to facilitate the manipulation of this strain and the functional characterization of the cluster genes. We have created a site-directed mutant unable to produce pederin, demonstrating experimentally for the first time the role of the cluster in the synthesis of pederin. This work paves the way to unravel the clues of the biosynthesis of pederin family compounds and opens the door to modify and overproduce these anticancer drugs for industrial and pharmaceutical purposes.

19.
Artigo em Inglês | MEDLINE | ID: mdl-31791636

RESUMO

BACKGROUND AND AIMS: The prevalence of hyperuricemia has increased substantially in recent decades. It has been suggested that it is an independent risk factor for weight gain, hypertension, hypertriglyceridemia, metabolic syndrome (MetS), and cardiovascular disease. Results from epidemiological studies conducted in different study populations have suggested that high consumption of dairy products is associated with a lower risk of developing hyperuricemia. However, this association is still unclear. The aim of the present study is to explore the association of the consumption of total dairy products and their subtypes with the risk of hyperuricemia in an elderly Mediterranean population with MetS. METHODS AND RESULTS: Baseline cross-sectional analyses were conducted on 6329 men/women (mean age 65 years) with overweight/obesity and MetS from the PREDIMED-Plus cohort. Dairy consumption was assessed using a food frequency questionnaire. Multivariable-adjusted Cox regressions were fitted to analyze the association of quartiles of consumption of total dairy products and their subtypes with the prevalence of hyperuricemia. Participants in the upper quartile of the consumption of total dairy products (multiadjusted prevalence ratio (PR) = 0.84; 95% CI: 0.75-0.94; P-trend 0.02), low-fat dairy products (PR = 0.79; 95% CI: 0.70-0.89; P-trend <0.001), total milk (PR = 0.81; 95% CI: 0.73-0.90; P-trend<0.001), low-fat milk (PR = 0.80; 95% CI: 0.72-0.89; P-trend<0.001, respectively), low-fat yogurt (PR = 0.89; 95% CI: 0.80-0.98; P-trend 0.051), and cheese (PR = 0.86; 95% CI: 0.77-0.96; P-trend 0.003) presented a lower prevalence of hyperuricemia. Whole-fat dairy, fermented dairy, and yogurt consumption were not associated with hyperuricemia. CONCLUSIONS: High consumption of total dairy products, total milk, low-fat dairy products, low-fat milk, low-fat yogurt, and cheese is associated with a lower risk of hyperuricemia.

20.
Cancers (Basel) ; 11(12)2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31795313

RESUMO

Early-onset colorectal cancer (EOCRC) is an increasing and worrisome entity. The aim of this study was to analyze its association with polyps concerning prognosis and surveillance. EOCRC cases were compared regarding the presence or absence of associated polyps (clinical and molecular features), during a minimum of 7 years of follow-up. Of 119 cases, 56 (47%) did not develop polyps (NP group), while 63 (53%) did (P group). The NP group showed a predominant location of the CRC in the rectum (50%), of sporadic cases (54%), and diagnosis at advanced stages: Only P53 and SMARCB1 mutations were statistically linked to this group. The P group, including mainly early-diagnosed tumors, was linked with the most frequent and differential altered chromosomal regions in the array comparative genomic hybridization. The two most frequent groups according to the follow-up were the NP group (40%), and patients developing polyps in the first 5 years of follow-up (P < 5FU) (34%) (these last groups predominantly diagnosed at the earliest stage and with adenomatous polyps (45%)). EOCRC with polyps that developed during the entire follow-up (PDFU group) were mainly located in the right colon (53%), diagnosed in earlier stages, and 75% had a familial history of CRC. Patients developing polyps after the first 5 years (P > 5FU) showed a mucinous component (50%). Our results show that the absence or presence of polyps in EOCRC is an important prognostic factor with differential phenotypes. The development of polyps during surveillance shows that it is necessary to extend the follow-up time, also in those cases with microsatellite-stable EOCRC.

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