La importancia de la genética en el estudio de la hipertrigliceridemia / The importance of genetics in the study of hypertriglyceridemia

La hipertrigliceridemia engloba un conjunto de trastornos lipídicos comunes en la práctica clínica, generalmente definidos como una concentración superior a 150mg/dL en ayunas. Existen diversas clasificaciones de la gravedad de la hipertrigliceridemia en función de sus valores séricos, considerándose por norma general moderada cuando los niveles son inferiores a 500mg/dL y severa cuando son mayores de 1.000mg/dL. Su importancia radica en su asociación con otras alteraciones del perfil lipídico, contribuyendo al aumento del riesgo cardiovascular y de pancreatitis aguda, fundamentalmente con concentraciones superiores a 500mg/dL.(AU)

Hypertriglyceridemia encompasses a set of lipid disorders common in clinical practice, generally defined as a fasting concentration above 150mg/dL. There are various classifications of the severity of hypertriglyceridaemia based on serum values, with levels generally considered moderate when below 500mg/dL and severe when above 1000mg/dL. Its importance lies in its association with other alterations in the lipid profile, contributing to increased cardiovascular risk and increased risk of acute pancreatitis, mainly with concentrations above 500mg/dL.(AU)

Emergencia hipertensiva como debut de síndrome de Cushing paraneoplásico / Hypertensive Emergency as the Debut of Paraneoplastic Cushing Syndrome

Presentamos el caso de un paciente con antecedentes de hipertensión arterial vasculorrenal tratada un año antes, que acude a urgencias por emergencia hipertensiva (HTA) y disnea. Descartada primera sospecha de reestenosis de arteria renal con angiografía por tomografía computarizada (angioTC), se completa el estudio confirmándose diagnóstico de cáncer de pulmón mediante prueba de imagen y anatomía patológica. En el estudio de hipertensión se detecta elevación de hormona adrenocorticótropa (ACTH), hipercortisolismo y datos analíticos de hiperaldosteronismo. Con el diagnóstico final de síndrome de Cushing secundario a producción ectópica de ACTH se inicia tratamiento médico, sin llegar a recibir nada más por fallecimiento del paciente a los pocos días.(AU)

We present the case of a patient with a history of renal-vascular hypertension treated with stent one year previously, who attended the emergency room due to hypertensive emergency and dyspnea. Once the first suspicion of renal artery restenosis was ruled out with CT angiography, the study was completed, confirming the diagnosis of lung cancer through imaging and pathological anatomy. In the hormonal study, elevation of ACTH, hypercortisolism and analytical data of hyperaldosteronism were detected. With the final diagnosis of Cushing's syndrome secondary to ectopic production of ACTH, medical treatment was started, without being able to receive anything else due to the death of the patient after a few days.(AU)

[WHEN MEDICATIONS ARE NOT ENOUGH - NEUROFEEDBACK AS A COMPLEMENTARY TREATMENT FOR POST-TRAUMATIC STRESS DISORDER - A CASE REPORT].

INTRODUCTION: Neurofeedback (NF) therapy is brain training using operant conditioning including real-time displays of brain activity to teach people how to regulate their brain function. We would like to present a treatment for a patient who experienced severe traumatic events on 7/10 including physical injury accompanied by difficulty sleeping for two months, nightmares, intrusive thoughts, difficulties in emotional regulation and difficulty in concentrating. Due to the complexity and difficulties in emotional regulation accompanied by severe sleep disturbances, it was decided to treat with medication in combination with neurofeedback. After several training sessions in addition to pharmaceutical treatment, significant relaxation was observed, there was an improvement in concentration and the patient was able to return to his work and normal social functioning. In addition, intrusive thoughts decreased in intensity and frequency.

[METATARSUS ADDUCTUS - A COMMON DEFORMITY - WHAT TO DO AND WHEN?]

INTRODUCTION: The most common foot deformity in newborns is the forefoot adduction deformity (FAD), where the hindfoot foot is in a normal position. The diagnosis for this problem is mainly based on a physical examination. The use of imaging methods has been described, but no advantage was shown with their utilization in determining the diagnosis and guiding treatment. Several classification systems have been proposed to characterize the degree of severity. The classifications are based on the degree of deviation and the flexibility of the foot. Early diagnosis and early treatment, if necessary, are extremely important to improve the chances of treatment success. Treatment depends on the severity of the deformity. For mild deformities the treatment is conservative - follow-up or stretching of the foot. The usual treatment for severe deformities is serial casting. Several orthoses have recently been proposed to address the problem and these demonstrated similar results, higher comfort and satisfaction, lower cost and a similar side effect profile. Surgical treatments to correct the deformity are reserved for cases where conservative treatment failed and for older children. This review aims to summarize the current knowledge on the subject, describe the ways to diagnose and classify the deformity, and present the variety of ways to treat the problem including the use of innovative braces. In addition, we will offer a protocol for the treatment of the deformity that is accepted in our institution. The protocol will assist primary care physicians to both diagnose and treat appropriate deformities, and know when a specialist referral is necessary.

[Digital environment and population health]. / Environnement digital et santé des populations.

Health and risk of disease are determined by exposure to the physical, socio-economic, and political environment and to this has been added exposure to the digital environment. Our increasingly digital lives have major implications for people's health and its monitoring, as well as for prevention and care. Digital health, which encompasses the use of health applications, connected devices and artificial intelligence medical tools, is transforming medical and healthcare practices. Used properly, it could facilitate patient-centered, inter-professional and data-driven care. However, its implementation raises major concerns and ethical issues, particularly in relation to privacy, equity, and the therapeutic relationship.

La santé et le risque de maladies sont déterminés par l'exposition aux environnements physiques, socio-économiques et politiques, et à cela s'est ajouté l'exposition à l'environnement digital. Notre vie digitale a des implications majeures, d'une part, sur la santé des populations et son monitoring et, d'autre part, sur la prévention et les soins. Ainsi, la santé digitale (digital health), qui englobe l'utilisation d'applications de santé, d'appareils connectés, ou d'outils médicaux d'intelligence artificielle, modifie les pratiques médico-soignantes. Bien utilisée, elle pourrait faciliter les soins centrés sur le patient, interprofessionnels et guidés par les données. Cependant, sa mise en œuvre soulève d'importants craintes et enjeux éthiques en lien notamment avec la protection des données, l'équité et la relation thérapeutique.

In Vivo Absorption and Lymphatic Bioavailability of Docosahexaenoic Acid from Microalgal Oil According to Its Physical and Chemical Form of Vectorization.

Docosahexaenoic acid (DHA) is an essential fatty acid (FA) with proven pro-health effects, but improving its bioavailability is becoming a public health issue. The bioavailability of DHA from microalgal (A) oil has been comprehensively assessed, particularly in terms of the molecular structuring capabilities offered by A-oil. Here, we explored the impact of five DHA-rich formulas differing in terms of (i) molecular structure, i.e., ethyl ester (EE), monoglyceride (MG), or triglyceride (TG), and (ii) supramolecular form, i.e., emulsified TG or TG + phospholipids (PL blend) on the lymphatic kinetics of DHA absorption and the lipid characteristics of the resulting lipoproteins. We demonstrated in rats that the conventional A-DHA TG structure afforded more effective DHA absorption than the EE structure (+23%). Furthermore, the A-DHA MG and A-DHA emulsions were the better DHA vectors (AUC: 89% and +42%, respectively) due to improved lipolysis. The A-DHA MG and A-DHA emulsion presented the richest DHA content in TG (+40%) and PL (+50%) of lymphatic chylomicrons, which could affect the metabolic fate of DHA. We concluded that structuring A-DHA in TG or EE form would better serve for tissue and hepatic metabolism whereas A-DHA in MG and emulsion form could better target nerve tissues.

Examining the relationship between self-efficacy, career development, and subjective wellbeing in physical education students.

We investigated the relationship between self-efficacy and career development via subjective well-being of students majoring in physical education. Life satisfaction, positive affect, and negative affect were the componennts of subjective well-being. Participants were the 1381 adolescents with major in physical education with an age range of 18-22 years (Mage = 19.5 ± 1; females = 34.76%). Hayes PROCESS model was used to develop a multiple mediation model. The results suggest that higher self-efficacy leads to better career development. Further, a significant mediating role was played by negative and positive affect in case of the relationship between self-efficacy and career exploration, but life-satisfaction is not significant mediator. Conversely, life satisfaction and positive affect are significant mediators between self-efficacy and career adaptability but negative affect is not. The findings suggest that self-efficacy and subjective well-being benefit career development of adolescents in the physical education field.

Developing an educational "hub": impact of a distance-learning curriculum in a multinational cohort.

PURPOSE: To address a gap in radiation oncology education in low- and middle-income countries (LMICs), we sought to evaluate the effectiveness and generalizability of a refined curriculum on intensity modulated radiotherapy (IMRT) offered to existing radiation therapy (RT) clinics across Africa and Latin America (LATAM) at no cost. METHODS: A curriculum was created based on prior needs assessments and adapted for participating medical physicists, radiation oncologists, radiation therapists, and trainees in LMICs. English-speaking and Spanish-speaking teams of volunteer educators delivered 27 hour-long sessions 1-2 times weekly for 4 months using video conferencing to African and LATAM cohorts, respectively. Pre- and post-course multiple-choice examinations were administered to LATAM participants, and pre- and post-course self-confidence (1-5 Likert-scale) and open-ended feedback were collected from all participants. RESULTS: Twenty-five centers across Africa (13) and LATAM (12) participated, yielding a total of 332 enrolled participants (128 African, 204 LATAM). Sessions were delivered with a mean of 44 (22.5) and 85 (25.4) participants in the African and LATAM programs, respectively. Paired pre and post-course data demonstrated significant (p < 0.001) improvement in knowledge from 47.9 to 89.6% and self-confidence across four domains including foundations (+ 1.1), commissioning (+ 1.3), contouring (+ 1.7), and treatment planning (+ 1.0). Attendance was a significant predictor of change in self-confidence in "high attendance" participants only, suggesting a threshold effect. Qualitative data demonstrates that participants look forward to applying their knowledge in the clinical setting. CONCLUSION: A specialized radiation oncology curriculum adapted for LMIC audiences was effective for both African and LATAM participants. Participant feedback suggests that the refined IMRT course empowered clinics with knowledge and confidence to help train others. This feasible "Hub and Spokes" approach in which a distance-learning course establishes a hub to be leveraged by spokes (learners) may be generalizable to others aiming to reduce global health care disparities through training efforts.

Is larger eccentric utilization ratio associated with poorer rate of force development in squat jump? An exploratory study.

This exploratory study examines the relationship between the eccentric utilization ratio (EUR) and the rate of force development (RFD) in squat jumps (SJ). EUR, a key metric in sports science, compares performance in countermovement jumps (CMJ) and squat jumps (SJ). The study hypothesizes that a higher EUR is associated with a poorer RFD in SJ. Basketball and soccer players, long-distance runners, alongside physical education students (209 men; age: 23.2 ± 4.95 years and 104 women; age: 22.7 ± 4.42 years) participated. The EUR was calculated from jump height, peak force and peak power. The results indicated a small to moderate but significant negative correlation between EUR based on peak force or peak power and RFD in SJ (r = -.41 and -.27), suggesting that a higher EUR might be linked to a diminished ability to rapidly develop force in SJ. Thus, a higher EUR may not indicate superior athletic performance.

Application of trauma-focused cognitive behavioral therapy among children and adolescents with childhood household dysfunction. / 创伤聚焦的认知行为疗法在童年家庭功能障碍儿童和青少年中的应用.

Childhood household dysfunction (CHD) is a common adverse childhood experience, which brings the heavy physical and mental afflictions to children and adolescents. Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy that helps children and adolescents who have experienced childhood trauma with traumatic memories. It aims to enhance the coping abilities of CHD children and adolescents, thereby improving the negative effects caused by trauma and effectively reducing psychological burden. TF-CBT can effectively improve post-traumatic stress disorder, emotional and behavioral problems, and family function in children and adolescents with CHD. It is recommended to conduct high-quality original research in the future, develop targeted TF-CBT intervention plans based on potential predictive factors, adopt a combination of online and offline methods, and construct TF-CBT interventions suitable for the Chinese CHD population to meet the mental health service needs of CHD children and adolescents.

Interrater Variability among Anaesthesiologists Using American Society of Anesthesiologists Physical Status Classification System.

BACKGROUND: The American Society of Anaesthesiologists Physical Status classification is deployed by the anaesthesiologists worldwide to classify operative surgical patients. Many studies have found moderate degree of interrater variability among anaesthesiologists. The general objective of the study was to find out interrater variability among Nepalese anesthesiologists using this classification system in Nepal. The specific objectives of the study were to find out the correctness of assignment and inter-rater variability among anaesthesiologists based on their experience. METHODS: Ten clinical cases were distributed among 130 registered anaesthesiologist practitioners of Nepal after validation with the experts. Respondents were asked to assign each of ten cases to a specific physical status class. Anaesthesiologists were classified to two classes based on clinical experience as having more or less than five years of experience. RESULTS: We found substantial agreement among < 5 year's (0.66) and > 5 year's experience group (0.753) and among all raters (0.736). The mean score of the group with less than 5 years of experience was more. There was no significant difference between the mean score (p = 0.595). Overall mean score for the both groups was 5.66 with SD 1.66. There was no significant difference between the groups. CONCLUSIONS: The study shows that there is very less variation among registered practising anaesthesiologists of Nepal using American Society of Anesthesiologists Physical Status classification system.

Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients.

In this Pro-Con commentary article, we discuss use of continuous physiologic monitoring for clinical deterioration, specifically respiratory depression in the postoperative population. The Pro position advocates for 24/7 continuous surveillance monitoring of all patients starting in the postanesthesia care unit until discharge from the hospital. The strongest arguments for universal monitoring relate to inadequate assessment and algorithms for patient risk. We argue that the need for hospitalization in and of itself is a sufficient predictor of an individual's risk for unexpected respiratory deterioration. In addition, general care units carry the added risk that even the most severe respiratory events will not be recognized in a timely fashion, largely due to higher patient to nurse staffing ratios and limited intermittent vital signs assessments (e.g., every 4 hours). Continuous monitoring configured properly using a "surveillance model" can adequately detect patients' respiratory deterioration while minimizing alarm fatigue and the costs of the surveillance systems. The Con position advocates for a mixed approach of time-limited continuous pulse oximetry monitoring for all patients receiving opioids, with additional remote pulse oximetry monitoring for patients identified as having a high risk of respiratory depression. Alarm fatigue, clinical resource limitations, and cost are the strongest arguments for selective monitoring, which is a more targeted approach. The proponents of the con position acknowledge that postoperative respiratory monitoring is certainly indicated for all patients, but not all patients need the same level of monitoring. The analysis and discussion of each point of view describes who, when, where, and how continuous monitoring should be implemented. Consideration of various system-level factors are addressed, including clinical resource availability, alarm design, system costs, patient and staff acceptance, risk-assessment algorithms, and respiratory event detection. Literature is reviewed, findings are described, and recommendations for design of monitoring systems and implementation of monitoring are described for the pro and con positions.

LAGSwin: Local attention guided Swin-transformer for thermal infrared sports object detection.

Compared with visible light images, thermal infrared images have poor resolution, low contrast, signal-to-noise ratio, blurred visual effects, and less information. Thermal infrared sports target detection methods relying on traditional convolutional networks capture the rich semantics in high-level features but blur the spatial details. The differences in physical information content and spatial distribution of high and low features are ignored, resulting in a mismatch between the region of interest and the target. To address these issues, we propose a local attention-guided Swin-transformer thermal infrared sports object detection method (LAGSwin) to encode sports objects' spatial transformation and orientation information. On the one hand, Swin-transformer guided by local attention is adopted to enrich the semantic knowledge of low-level features by embedding local focus from high-level features and generating high-quality anchors while increasing the embedding of contextual information. On the other hand, an active rotation filter is employed to encode orientation information, resulting in orientation-sensitive and invariant features to reduce the inconsistency between classification and localization regression. A bidirectional criss-cross fusion strategy is adopted in the feature fusion stage to enable better interaction and embedding features of different resolutions. At last, the evaluation and verification of multiple open-source sports target datasets prove that the proposed LAGSwin detection framework has good robustness and generalization ability.

Cumulative effects of excess high-normal alanine aminotransferase levels in relation to new-onset metabolic dysfunction-associated fatty liver disease in China.

BACKGROUND: Within the normal range, elevated alanine aminotransferase (ALT) levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease (MAFLD). AIM: To investigate the associations between repeated high-normal ALT measurements and the risk of new-onset MAFLD prospectively. METHODS: A cohort of 3553 participants followed for four consecutive health examinations over 4 years was selected. The incidence rate, cumulative times, and equally and unequally weighted cumulative effects of excess high-normal ALT levels (ehALT) were measured. Cox proportional hazards regression was used to analyse the association between the cumulative effects of ehALT and the risk of new-onset MAFLD. RESULTS: A total of 83.13% of participants with MAFLD had normal ALT levels. The incidence rate of MAFLD showed a linear increasing trend in the cumulative ehALT group. Compared with those in the low-normal ALT group, the multivariate adjusted hazard ratios of the equally and unequally weighted cumulative effects of ehALT were 1.651 [95% confidence interval (CI): 1.199-2.273] and 1.535 (95%CI: 1.119-2.106) in the third quartile and 1.616 (95%CI: 1.162-2.246) and 1.580 (95%CI: 1.155-2.162) in the fourth quartile, respectively. CONCLUSION: Most participants with MAFLD had normal ALT levels. Long-term high-normal ALT levels were associated with a cumulative increased risk of new-onset MAFLD.

Prospective diagnostic accuracy study of history taking and physical examination for adults with vertigo in general practice: study protocol.

INTRODUCTION: Vertigo is a prevalent and burdensome symptom. More than 80% of patients with vertigo are primarily treated by their general practitioner (GP) and are never referred to a medical specialist. Despite this therapeutic responsibility, the GP's diagnostic toolkit has serious limitations. All recommended tests lack empirical evidence, because a diagnostic accuracy study on vestibular disorders ('How well does test x discriminate between patients with or without target condition y?') has never been performed in general practice. The VERtigo DIagnosis study aims to fill this gap. METHODS AND ANALYSIS: We will perform a diagnostic accuracy study on vertigo of primary vestibular origin in general practice to assess the discriminative ability of history taking and physical examination. We will compare all index tests with a respective reference standard. We will focus on five target conditions that account for more than 95% of vertigo diagnoses in general practice: (1) benign paroxysmal positional vertigo, (2) vestibular neuritis, (3) Ménière's disease, (4) vestibular migraine (VM) and (5) central causes other than VM. As these five target conditions have a different pathophysiology and lack one generally accepted gold standard, we will use consensus diagnosis as a construct reference standard. Data for each patient, including history, physical examination and additional tests as recommended by experts in an international Delphi procedure, will be recorded on a standardised form and independently reviewed by a neurologist and otorhinolaryngologist. For each patient, the reviewers have to decide about the presence/absence of each target condition. We will calculate sensitivity, specificity, predictive values, likelihood ratios and diagnostic ORs, followed by decision rules for each target condition. ETHICS AND DISSEMINATION: The study obtained approval from the Vrije Universiteit Medical Center Medical Ethical Review Committee (reference: 2022.0817-NL83111.029.22). We will publish our findings in peer-reviewed international journals. TRIAL REGISTRATION NUMBER: ISRCTN97250704.

Perichondritis and auricular cellulitis related to piercings as first manifestation of monkeypox / Pericondritis y celulitis auricular relacionadas con piercings como primera manifestación de viruela del mono

Introduction: Pinna infections are usually due to Staphylococcus aureus infection. It is common for the patient to have had an earring in the area of infection. Monkeypox infection has gone from being an endemic infection to a worldwide health emergency. Case summary: In this article we present five cases of monkeypox earring infection of the pinna and what common features we have seen that differentiate them from Staphylococcus aureus infection. Discussion: Symptoms of monkeypox include general malaise, fever with uni- or bilateral lymphadenopathy, and then the appearance within one or two days of skin lesions, we want to alert he otolaryngologist and the medical society to the possibility the diagnostic possibility of monkeypox in patients with an auricular perichondritis.(AU)

Introducción: Las infecciones del pabellón auricular se deben habitualmente a la infección por Staphilococcus Aureus. Es habitual que el paciente se haya realizado un pendiente en la zona de la infección. La infección por viruela del Mono ha pasado de ser una infección endémica a una emergencia sanitaria a nivel mundial. Caso: Exponemos en este artículo cinco casos de infección del pabellón auricular por pendiente por viruela del mono y que características comunes hemos visto que las diferencian de la infección por Staphilococcus Aureus. Discusión:Los síntomas de la viruela del mono incluyen malestar general, fiebre con linfadenopatía uni o bilateral, y posteriormente la aparición en uno o dos días de lesiones cutáneas, queremos alertar al otorrinolaringólogo y a la sociedad médica de la posibilidad diagnóstica de viruela del mono en pacientes con una pericondritis auricular.(AU)