Time course and management of key adverse events during the randomized phase III SOLAR-1 study of PI3K inhibitor alpelisib plus fulvestrant in patients with HR-positive advanced breast cancer.

BACKGROUND: Alpelisib (α-selective phosphatidylinositol 3-kinase inhibitor) plus fulvestrant is approved in multiple countries for men and postmenopausal women with PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer following progression on or after endocrine therapy. A detailed understanding of alpelisib's safety profile should inform adverse event (AE) management and enhance patient care. PATIENTS AND METHODS: AEs in the phase III SOLAR-1 trial were assessed in patients with and without PIK3CA mutations. The impact of protocol-specified AE-management recommendations was evaluated, including an amendment to optimize hyperglycemia and rash management. RESULTS: Patients were randomly assigned to receive fulvestrant plus alpelisib (n = 284) or placebo (n = 287). The most common grade 3/4 AEs with alpelisib were hyperglycemia (grade 3, 32.7%; grade 4, 3.9%), rash (grade 3, 9.9%), and diarrhea (grade 3, 6.7%). Median time to onset of grade ≥3 toxicity was 15 days (hyperglycemia, based on fasting plasma glucose), 13 days (rash), and 139 days (diarrhea). Metformin alone or in combination with other antidiabetic agents was used by most patients (87.1%) with hyperglycemia. Preventive anti-rash medication resulted in lower incidence (any grade, 26.7% versus 64.1%) and severity of rash (grade 3, 11.6% versus 22.7%) versus no preventative medication. Discontinuations due to grade ≥3 AEs were lower following more-detailed AE management guidelines (7.9% versus 18.1% previously). Patients with PIK3CA mutations had a median alpelisib dose intensity of 248 mg/day. Median progression-free survival with alpelisib was 12.5 and 9.6 months for alpelisib dose intensities of ≥248 mg/day and <248 mg/day, respectively, compared with 5.8 months with placebo. CONCLUSIONS: Hyperglycemia and rash occurred early during alpelisib treatment, while diarrhea occurred at a later time point. Early identification, prevention, and intervention, including concomitant medications and alpelisib dose modifications, resulted in less severe toxicities. Reductions in treatment discontinuations and improved progression-free survival at higher alpelisib dose intensities support the need for optimal AE management. CLINICALTRIALS. GOV ID: NCT02437318.

Short, full-dose adjuvant chemotherapy (CT) in high-risk adult soft tissue sarcomas (STS): long-term follow-up of a randomized clinical trial from the Italian Sarcoma Group and the Spanish Sarcoma Group.

BACKGROUND: To report on long-term results of a phase 3 trial comparing three versus five cycles of adjuvant chemotherapy (CT) with full-dose epirubicin+ifosfamide in high-risk soft tissue sarcomas (STS). METHODS: Patients (pts) were randomized to receive three preoperative cycles of epirubicin 120 mg/m2 and ifosfamide 9 g/m2 (Arm A) or to receive the same three preoperative cycles plus two postoperative cycles (Arm B). Radiotherapy could be either delivered in the preoperative or in the postoperative setting. Non-inferiority of the primary end point, OS, was assessed by the confidence interval of the hazard ratio (HR; Arm A/Arm B) derived from Cox model. RESULTS: Between January 2002 and April 2007, 164 pts were assigned to arm A and 164 to arm B. At a median follow-up (FU) of 117 months (IQ range 103-135 months), 123 deaths were recorded: 58 in Arm A and 65 in Arm B. Ten-year OS was 61% for the entire group of patients: 64% in Arm A and 59% in Arm B. The intention-to-treat analysis confirmed that three cycles were not inferior to five cycles (one-sided 95% upper confidence limit was 1.24). A per protocol analysis was consistent with these results. Pts with leiomyosarcoma and undifferentiated pleomorphic sarcoma (UPS) had the lowest, and the highest response rates, respectively. Consistently, Leiomyosarcoma and UPS had the worse and the best prognosis, respectively. CONCLUSIONS: At a longer FU, the non-inferiority of three cycles of a full-dose conventional CT in comparison to five is confirmed. Response to therapy is also confirmed to be associated with better survival. This regimen is currently tested within an ongoing international trial against three cycles of a neoadjuvant histology-tailored CT (ClinicalTrials.gov Identifier: NCT01710176).

The treatment with the probiotic Shewanella putrefaciens Pdp11 of specimens of Solea senegalensis exposed to high stocking densities to enhance their resistance to disease.

Aquaculture industry exposes fish to acute stress events, such as high stocking density, and a link between stress and higher susceptibility to diseases has been concluded. Several studies have demonstrated increased stress tolerance of fish treated with probiotics, but the mechanisms involved have not been elucidated. Shewanella putrefaciens Pdp11 is a strain isolated from healthy gilthead seabream (Sparus aurata L.) and it is considered as probiotics. The aim of this study was to evaluate the effect of the dietary administration of this probiotics on the stress tolerance of Solea senegalensis specimens farmed under high stocking density (PHD) compared to a group fed a commercial diet and farmed under the same conditions (CHD). In addition, during the experiment, a natural infectious outbreak due to Vibrio species affected fish farmed under crowding conditions. Changes in the microbiota and histology of intestine and in the transcription of immune response genes were evaluated at 19 and 30 days of the experiment. Mortality was observed after 9 days of the beginning of the experiment in CHD and PHD groups, it being higher in the CHD group. Fish farmed under crowding stress showed reduced expression of genes at 19 day probiotic feeding. On the contrary, a significant increase in immune related gene expression was detected in CHD fish at 30 day, whereas the gene expression in fish from PHD group was very similar to that showed in specimens fed and farmed with the conventional conditions. In addition, the dietary administration of S. putrefaciens Pdp11 produced an important modulation of the intestinal microbiota, which was significantly correlated with the high number of goblet cells detected in fish fed the probiotic diet.

Traditional sexing methods and external egg characteristics combination allow highly accurate early sex determination in an endangered native turkey breed.

Early sex determination methods are not only crucial in the worldwide massive poultry industry, but also for small-holder producers. The profitability of sexing techniques must be accounted for when aiming to boost management, nutrition, and conservation practices in endangered poultry breeds. This becomes pivotal when the local breed dealt with belongs to an understudied species, such as the turkey. So, the main objective of this study is to identify which method combination may report a higher likelihood of successful sex determination in poults across the three-pattern varieties of the Andalusian turkey breed. A total of 84 one to two days old Andalusian turkey poults (42 black, 28 black-roan, and 14 bronze-roan) were evaluated in this study. Sex determination was performed using 15 methods, which included testing external egg metrics and eggshell color, poult morphological appraisal and phaneroptics, and behavioral traits. Possible differences across plumage varieties and the interaction between sex and plumage were observed when external egg quality was measured. Sex determination through behavioral methods in black base feathered (black and black-roan) male sex individuals showed seven times higher sensitivity when compared to the rest of the studied individuals (χ2 = 7.14, df = 1, P < 0.01). In contrast, for the black-roan plumage females, the method based on the color of down feathers was approximately four times more sensitive (χ2 = 3.95, df = 1, P ≤ 0.05). For the bronze-roan pattern, none of the sexing techniques was reported to efficiently predict sex itself. However, the most proper method combination to determine sex, independent of plumage color, was physical external egg characteristics, the color of down feathers, and behavioral approaches ("English method" and "slap technique"). The specificity values were found to be 49.12, 93.33, and 100%, while the sensitivity values were observed to be 74.64, 91.03, and 100%, which translated into accuracy of 63.10, 92.26, and 100% in black, black-roan, and bronze-roan poults, respectively. Our results suggest that the method combination tested in this study could be considered a highly accurate, simple, and affordable alternative for sex determination in turkeys. This could mean a pivotal advance for small producers of turkeys, as early sex detection can help to plan timely conservational management strategies, which is of prominent importance in the context of endangered poultry breeds.

Authentication of fattening diet of Iberian pigs according to their volatile compounds profile from raw subcutaneous fat.

The composition of volatile components of subcutaneous fat from Iberian pig has been studied. Purge and trap gas chromatography-mass spectrometry has been used. The composition of the volatile fraction of subcutaneous fat has been used for authentication purposes of different types of Iberian pig fat. Three types of this product have been considered, montanera, extensive cebo and intensive cebo. With classification purposes, several pattern recognition techniques have been applied. In order to find out possible tendencies in the sample distribution as well as the discriminant power of the variables, principal component analysis was applied as visualisation technique. Linear discriminant analysis (LDA) and soft independent modelling by class analogy (SIMCA) were used to obtain suitable classification models. LDA and SIMCA allowed the differentiation of three fattening diets by using the contents in 2,2,4,6,6-pentamethyl-heptane, m-xylene, 2,4-dimethyl-heptane, 6-methyl-tridecane, 1-methoxy-2-propanol, isopropyl alcohol, o-xylene, 3-ethyl-2,2-dimethyl-oxirane, 2,6-dimethyl-undecane, 3-methyl-3-pentanol and limonene.

Success of medical therapy in a rare case of cecal ameboma.

INTRODUCTION: Colitis caused by Entamoeba histolytica (EH) is prevalent in developing countries. Clinical presentation ranges from mild diarrhoea episodes to dysentery and liver abscess. Ameboma, a complication caused by EH invasion of the intestinal wall, is a rare presentation of amebiasis, occurring approximately in 1.5% of cases. Because of its insidious and variable clinical presentation only few cases are diagnosed previous to surgical intervention. We report a 52 years old Mexican-mestizo female, presenting with a pain-less right lower quadrant abdominal mass and diagnosed of cecal ameboma prior to surgery by colonoscopy and histopathologic examination. The present case highlights the importance of early diagnosis and medical therapy with antiparasitic drugs in order to avoid complications that could lead these patients to unnecessary surgical management.

SEOM Clinical Guideline of management of soft-tissue sarcoma (2020).

Soft-tissue sarcomas constitute an uncommon and heterogeneous group of tumors of mesenchymal origin. Diagnosis, treatment, and management should be performed by an expert multidisciplinary team. MRI/CT of the primary tumor and biopsy is mandatory before any treatment. Wide surgical resection with tumor-free tissue margin is the mainstay for localized disease. Radiotherapy is indicated in large, deep, high-grade tumors, or after marginal resection not suitable for re-excision. Perioperative chemotherapy should be discussed for high-risk sarcomas of the extremities and trunk-wall. In the case of oligometastatic disease, patients should be considered for local therapies. First-line treatment with anthracyclines (or in combination with ifosfamide) is the treatment of choice. Other drugs have shown activity in second-line therapy and in specific histological subtypes but options are limited and thus, a clinical trial should always be discussed.

New models for donor-recipient matching in lung transplantations.

OBJECTIVE: One of the main problems of lung transplantation is the shortage of organs as well as reduced survival rates. In the absence of an international standardized model for lung donor-recipient allocation, we set out to develop such a model based on the characteristics of past experiences with lung donors and recipients with the aim of improving the outcomes of the entire transplantation process. METHODS: This was a retrospective analysis of 404 lung transplants carried out at the Reina Sofía University Hospital (Córdoba, Spain) over 23 years. We analyzed various clinical variables obtained via our experience of clinical practice in the donation and transplantation process. These were used to create various classification models, including classical statistical methods and also incorporating newer machine-learning approaches. RESULTS: The proposed model represents a powerful tool for donor-recipient matching, which in this current work, exceeded the capacity of classical statistical methods. The variables that predicted an increase in the probability of survival were: higher pre-transplant and post-transplant functional vital capacity (FVC), lower pre-transplant carbon dioxide (PCO2) pressure, lower donor mechanical ventilation, and shorter ischemia time. The variables that negatively influenced transplant survival were low forced expiratory volume in the first second (FEV1) pre-transplant, lower arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2) ratio, bilobar transplant, elderly recipient and donor, donor-recipient graft disproportion requiring a surgical reduction (Tailor), type of combined transplant, need for cardiopulmonary bypass during the surgery, death of the donor due to head trauma, hospitalization status before surgery, and female and male recipient donor sex. CONCLUSIONS: These results show the difficulty of the problem which required the introduction of other variables into the analysis. The combination of classical statistical methods and machine learning can support decision-making about the compatibility between donors and recipients. This helps to facilitate reliable prediction and to optimize the grafts for transplantation, thereby improving the transplanted patient survival rate.

Clinical screening and diagnosis of diabetic polyneuropathy: the North Catalonia Diabetes Study.

BACKGROUND: To evaluate the prevalence of diabetic polyneuropathy (DPN) and develop a simple and accurate method for the evaluation of DPN risk in primary care settings. MATERIALS AND METHODS: Cross-sectional descriptive study in a random sample (N = 307) of type 2 diabetes mellitus participants. DPN was diagnosed by both clinical neurological examination and simplified DPN Selection Method in each patient. Correlation between the two methods was obtained. RESULTS: Prevalence of DPN was 23.13% (confidence interval,18.38-27.87) according to clinical neurological examination. Noteworthy, clinical neurological evaluation scores were related to nerve conduction studies (r = 0.882; P < 0.0005). DPN presence was positively related to age, metabolic control (HbA1c levels), known duration of diabetes, diabetic retinopathy, cardiovascular disease, peripheral ischemia and systolic and diastolic blood pressure, but was negatively related to current high-density lipoprotein cholesterol (HDL-C) levels (P < 0.0001). The sensitivity and specificity of our DPN Selection Method (using four clinical parameters: age, retinopathy, HbA1c and HDL-C plasma levels) for diagnosis of DPN was 74.20% and 74.90%, respectively. CONCLUSIONS: The expected prevalence of DPN was observed. The sensitivity of the DPN Selection Method correlated well with formal clinical neurological exam in detection of the condition. We therefore conclude the DPN Selection Method is a useful tool in primary care settings in the evaluation and diagnosis of DPN.

Second complete remission induced by cyclophosphamide plus bevacizumab in two patients with heavily pre-treated ovarian cancer.

During the last decade we have been developing new therapeutic strategies for the treatment of ovarian cancer, based on the best knowledge of the molecular biology. New drugs like bevacizumab are showing antiangiogenic antitumour activity in ovarian cancer in preclinical models and in clinical trials. Bevacizumab is a monoclonal human antibody that has showed activity in both monotherapy and in combination with other therapies. We present the outcome of two patient cases with recurring heavily pre-treated ovarian cancer that were treated with cyclophosphamide and bevacizumab in combination and showed a complete remission of disease. After interruption of the treatment with bevacizumab, both patients had a disease relapse. Despite poor prognosis of the disease, in both cases a second complete and maintained remission was achieved, again with the same regimen.

Bulk Ti nitride prepared from rutile TiO2 for its application as stimulation electrode in neuroscience.

Bulk titanium nitride (TiN) was synthesized by nitridation of TiO2 rutile substrates. TiN pellets were successfully achieved at 1100 °C in ammonia stream; these materials were characterized by the evaluation of their microstructure, surface, chemical composition and electrical and electrochemical properties, concluding that the synthesis promotes the creation of a TiNxOy surface, which shows high metallic conductivity (close to 102 S/cm) and a microstructure with micro- and nano-features. Electrochemical studies reveal high storage capacities which are delivered through an injection mechanism that involves the double charge layer and EIS show a high capacitive contribution to the mechanism. Neuron cell cultures assessed the biocompatibility of the sample prepared and put forward this material as a promising candidate for implantable stimulation electrode in neuroscience.

Rescue of Discarded Grafts for Liver Transplantation by Ex Vivo Subnormothermic and Normothermic Oxygenated Machine Perfusion: First Experience in Spain.

BACKGROUND: Ex vivo machine perfusion (MP) has been reported as a possibly method to rescue discarded organs. The main aim of this study was to report an initial experience in Spain using MP for the rescue of severely marginal discarded liver grafts, and to, secondarily, define markers of viability to test the potential applicability of these devices for the real increase in the organ donor pool. METHODS: The study began in January 2016. Discarded grafts were included in a research protocol that consisted of standard retrieval followed by 10 hours of cold ischemia. Next, either normothermic (NMP) or controlled subnormothermic (subNMP) rewarming was chosen randomly. Continuous measurements of portal-arterial pressure and resistance were screened. Lactate, pH, and bicarbonate were measured every 30 minutes. The perfusion period was 6 hours, after which the graft was discarded and evaluated as potentially usable, but never implanted. Biopsies of the donor and at 2, 4, and 6 hours after ex vivo MP were obtained. RESULTS: A total of 4 grafts were included in the protocol. The first 2 grafts were perfused by NMP and grafts 3 and 4 by subNMP. The second and third grafts showed a clear trend toward optimal recovery and may have been used. Lactate dropped to levels below 2.5 mmol/L with stable arterial and portal pressure and resistance. Clear biliary output started during MP. Biopsies showed an improvement of liver architecture with reduced inflammation at the end of the perfusion. CONCLUSION: This preliminary experience has demonstrated the potential of MP devices for the rescue of severely marginal liver grafts. Lactate and biliary output were useful for viability testing of the grafts. The utility of NMP or subNMP protocols requires further research.

Differentiation of certified brands of origins of Spanish white wines by HS-SPME-GC and chemometrics.

A headspace solid-phase microextraction gas-chromatographic (HS-SPME-GC) procedure was used to determine the composition of the volatile fraction of white wine samples from several Spanish certified brands of origin (CBO). The compounds present were previously identified by gas chromatography-mass spectrometry (GC-MS) and quantitative determinations were carried out by GC-FID. Four CBO, Rueda, Ribeiro, Penedés, and Condado de Huelva, were studied. Rueda wines present the highest concentrations of ethyl acetate (55.86-125.27 microg mL(-1)), isoamyl acetate (0.91-6.72 microg mL(-1)), hexyl acetate (0.09-0.81 microg g mL(-1)), and 2-phenethyl acetate (0.14-0.66 microg mL(-1)). Compounds such as ethyl hexanoate (0.88-2.15 microg mL(-1)) and ethyl decanoate (0.29-0.96 microg mL(-1)) appeared in higher concentration in Ribeiro, Rueda, and Penedés samples. According to the results obtained and by applying pattern-recognition procedures differentiation of the considered CBO was attained. Principal-component analysis (PCA), linear discriminant analysis (LDA), and multilayer perceptrons neural networks (MLP-NN) were used as chemometric tools for pattern-recognition studies.

A deletion in the bone morphogenetic protein 15 gene causes sterility and increased prolificacy in Rasa Aragonesa sheep.

Bone morphogenetic protein 15 (BMP15) is a member of the transforming growth factor beta superfamily, is specifically expressed in oocytes and is essential for sheep prolificacy. Reported mutations in this gene cause increased ovulation rate and infertility in a dosage-sensitive manner. In this work, a new naturally occurring mutation in the BMP15 gene from the ovine Rasa Aragonesa breed is described. This mutation is a deletion of 17 bp that leads to an altered amino acid sequence and introduces a premature stop codon in the protein. Highly significant associations (P < 0.0001) were found between the estimated breeding value for prolificacy and the genotype of BMP15 in Rasa Aragonesa animals with high and low breeding values for this trait. As for other mutations in BMP15, this new mutation is associated with increased prolificacy and sterility in heterozygous and homozygous ewes respectively.

Differentiation of green, white, black, Oolong, and Pu-erh teas according to their free amino acids content.

In this paper, the differentiation of green, black, Oolong, white, and Pu-erh teas has been carried out according to their free amino acid contents. Alanine, arginine, asparagine, aspartic acid, glutamic acid, isoleucine, histidine, leucine, phenylalanine, serine, theanine, threonine, and tyrosine have been determined by liquid chromatography with derivatization with o-phthalaldehyde and fluorescence detection. The chromatographic separation was achieved with a Hypersil ODS column and gradient elution. The amino acid contents were used as chemometric descriptors for classification purposes of different tea varieties. Principal component analysis, k-nearest neighbors, linear discriminant analysis, and artificial neural networks were applied to differentiate tea varieties. Using back-propagation multilayer perceptron artificial neural networks, 100% success in the classification was obtained. The most differentiating amino acids were glutamic acid, asparagine, serine, alanine, leucine, and isoleucine.

Fluorometric determination of mixtures of quinolones by means of partial least squares and neural networks.

Multivariate calibration methods (partial least squares calibration, back propagation multilayer perceptrons networks, radial basis functions and generalized regression neural networks) were applied to the simultaneous fluorometric quantification of levofloxacin, garenoxacin and grepafloxacin, without previous separation steps. A data matrix was obtained by registering the emission spectra of mixtures of the three quinolones in urine (with concentrations ranging over 0.00-0.40 microg mL-1 for each quinolone) with a 283 nm excitation at pH 4.0. The generalized regression neural network model proved to be the most adequate model for simultaneous quantification of the three quinolones in urine samples.

Some practical considerations for linearity assessment of calibration curves as function of concentration levels according to the fitness-for-purpose approach.

Since linear calibration is mostly preferred for analytical determinations, linearity in the calibration range is an important performance characteristic of any instrumental analytical method. Linearity can be proved by applying several graphical and numerical approaches. The principal graphical criteria are visual inspection of the calibration plot, the residuals plot, and the response factors plot, also called sensitivity or linearity plot. All of them must include confidence limits in order to visualize linearity deviations. In this work, the graphical representation of percent relative errors of back-calculated concentrations against the concentration of the calibration standards is proposed as linearity criterion. This graph considers a confidence interval based on the expected recovery related to the concentration level according to AOAC approach. To illustrate it, four calibration examples covering different analytical techniques and calibration situations have been studied. The proposed %RE graph was useful in all examples, helping to highlight problems related to non-linear behavior such as points with high leverage and deviations from linearity at the extremes of the calibration range. By this way, a numerical decision limit which takes into account the concentration of calibration standards can be easily included as linearity criterion in the form of %RETh=2·C-0.11. Accordingly, this %RE parameter is accurate for the decision-making related to linearity assessment according to the fitness-for-purpose approach.

Autonomic function and its relationship with central obesity and hemodynamic variables in obese and overweight adults / Función autonómica y su relación con la obesidad central y las variables hemodinámicas en adultos obesos y con sobrepeso

Introduction: central obesity is associated with an autonomic dysfunction characterized by an increase in sympathetic activity and a reduction in vagal tone, leading to a decrease in heart rate variability. Objective: we aimed to analyze the relationship between the time and frequency domains of heart rate variability with central obesity, and its hemodynamic variables in normal-weight, overweight and obese adults. Methods: a total of 65 adults were evaluated (25.4 ± 3.2 years old) and distributed in 3 groups: normal weight group (NW group), overweight group (OW group) and obese group (OB group). Heart rate variability parameters at rest and both anthropometric and hemodynamic variables were recorded. Results: the results showed a positive correlation between waist circunference and LF/HF ratio in the OW (p = 0.0008; r = 0.6607; r2 = 0.4365) and OB (p = 0.0001; r = 0.8286; r2 = 0.6866) groups. The waist-to-height ratio showed significant differences with HF in the NW, OW, and OB groups. The variables related to the parasympathetic system (SDNN, RMSSD, pNN50, HF) in the OB and OW groups showed a decrease in values when compared to the NW group. Likewise, the variable related to the sympathetic system (LF) in the OB and OW groups increased its values when compared with the NW group. The LF/HF ratio increased from the NW group to the OW and OB groups (1.6 ± 0.7; 2.5 ± 1.8 and 3.3 ± 0.7). Conclusion: overweight and obese adults present a modulation of sympathetic activity predominance at rest. This increased activity is represented by the time and frequency domains of heart rate variability, having an important correlation with waist circumference and waist-to-height ratio (AU)

Introducción: la obesidad central se asocia con una disfunción autonómica caracterizada por una mayor actividad simpática y reducción del tono vagal, conduciendo a una disminución de la variabilidad de la frecuencia cardíaca (VFC). Objetivo: analizar la relación entre los dominios de tiempo y frecuencia de la VFC con la obesidad central y sus variables hemodinámicas en adultos con peso normal, sobrepeso y obesidad. Metodología: participaron 65 adultos (25,4 ± 3,2 años) distribuidos en 3 grupos: peso normal (grupo NW), sobrepeso (grupo OW) y obesidad (grupo OB). Se registraron los parámetros de la VFC y las variables antropométricas y hemodinámicas. Resultados: se observó una correlación positiva entre la circunferencia de la cintura y la relación LF/HF en el grupo OW (p = 0,0008; r = 0,6607; r2 = 0,4365) y OB (p = 0,0001; r = 0,8286; r2 = 0,6866). La relacion cintura/altura mostró una diferencia significativa con la HF en los grupos NW, OW y OB. La actividad parasimpática (SDNN, RMSSD, pNN50, HF) de los grupos OB y OW evidenció una disminución de los valores en comparación con el grupo NW. La actividad simpática (LF) en el grupo OB y OW presentó mayores valores que en el grupo NW. La relación LF/HF aumentó del grupo NW hacia el OW y el OB (1,6 ± 0,7; 2,5 ± 1,8 y 3,3 ± 0,7). Conclusiones: el sobrepeso y la obesidad presentan una predominancia de la actividad simpática en reposo. Este aumento de la actividad está representado en el dominio de tiempo y frecuencia de la VFC y, además, presenta una correlación importante con la circunferencia de la cintura y la relación cintura/altura (AU)

Recurring enteric peritonitis associated with non-perforating colon carcinoma.

Peritonitis of enteric origin may occur during treatment with peritoneal dialysis due to visceral perforation or injury or, in the absence of perforation, due to transmural migration of enteric bacteria across the bowel wall into the peritoneal cavity. To the best of our knowledge, peritonitis has not previously been reported associated with carcinomatous colon polyp in the absence of bowel wall perforation. We describe the case of a 31-year-old female who experienced recurring episodes of enteric peritonitis associated with a clinically occult adenocarcinoma of the colon, without having any other known risk factors for peritonitis. A 15 mm carcinomatous polyp was not visible on CT scan but was found at colonoscopy with polypectomy. She proceeded to transverse colectomy; the resected colon showed no evidence of bowel wall perforation. This case demonstrates that a non-perforating carcinomatous polyp of the colon may predispose to enteric peritonitis in the setting of peritoneal dialysis, and it emphasizes the importance of making an aggressive search for underlying pathology, in patients who present with recurring enteric peritonitis or unusual presentations of enteric peritonitis.