Performance of Indocyanine green for sentinel lymph node mapping and lymph node metastasis in colorectal cancer: a diagnostic test accuracy meta-analysis.

BACKGROUND: Indocyanine green has been widely employed as a secure and easy technique for sentinel lymph node mapping in different types of cancer. Nonetheless, the usage of Indocyanine green has not been fully implemented due to the heterogeneous results found in published studies. Thus, the objective of this meta-analysis is to evaluate the overall performance of Indocyanine green for sentinel lymph node mapping and node metastasis in patients undergoing colorectal cancer surgery. METHODS: An extensive systematic search was performed to identify relevant studies in English and Spanish with no time limit restrictions. For the meta-analysis, a hierarchical summary receiver operating characteristic curve (HSROCs) was constructed, and quantitative data synthesis was performed using random effects models. Specificity, sensitivity, positive, and negative likelihood ratios were obtained from the corresponding HSROC. Between-study heterogeneity was visually evaluated using Galbraith plot, and publication bias was quantified using Deeks' method. RESULTS: A total of 11 studies were included for analysis. The pooled detection rate for sentinel lymph node mapping was 91% (80-98%). Covariates significantly influencing the pooled detection rate were having colon cancer (estimate: 1.3001; 1.114 to 1.486; p < 0.001) and the usage of a laparoscopic approach (estimate: 1.3495; 1.1029 to 1.5961; p < 0.001). The performance of Indocyanine green for the detection of metastatic lymph nodes yielded an area under the roc curve of 66.5%, sensitivity of 64.3% (51-76%), and specificity of 65% (36-85%). CONCLUSIONS: Indocyanine green for the detection of sentinel lymph node mapping demonstrates better accuracy when used in colonic cancer and by a laparoscopic approach. Nevertheless, its overall performance for the detection of lymph node metastasis is poor.

Impact of the ENDORSE study results on thromboprophylaxis prescribing patterns in medical patients attending the emergency department.

AIMS: The aim of the study was to evaluate the impact of the ENDORSE study results on thromboprophylaxis prescribing patterns in medical patients attending the Emergency Department (ED) by assessing prescribing appropriateness at admission. METHODS: A cross-sectional, observational, descriptive study was designed and included all adult medical patients admitted from an ED between 20 November 2012 and 26 November 2012 at a large tertiary hospital. Patients to whom anticoagulants were prescribed for therapeutic purposes, patients admitted to Intensive Care Unit or maternity wards were excluded. Prescribing appropriateness was assessed using the Padua Prediction Score (ACCP 2012 guideline) for thromboembolic risk assessment and the NICE model to determine risk of bleeding. The primary end-point was the adequacy of thromboprophylaxis prescribed at the ED according to the ACCP 2012 guideline. RESULTS: A total of 393 patients were examined and 207 patients were included in the study (53.1% were male) with a median age of 75.3 years. The most common diagnosis at admission was related to a respiratory disease (41.1%). In 34.8% of the patients (72 patients), the recommendation of prophylaxis according to ACCP 2012 guideline did not match with the prophylaxis prescribed at admission. Reasons for non-concordance were undertreatment (14.5%) and overtreatment (20.3%). CONCLUSIONS: The adequacy of thromboprophylaxis in high risk patients for VTE has improved compared with the ENDORSE study. However, the percentage of patients with discordant prescriptions remains high. Despite the existence of treatment omissions, this percentage has been overcome by patients overtreated.

Excessive fructose intake induces the features of metabolic syndrome in healthy adult men: role of uric acid in the hypertensive response.

BACKGROUND: Excessive fructose intake causes metabolic syndrome in animals and can be partially prevented by lowering the uric acid level. We tested the hypothesis that fructose might induce features of metabolic syndrome in adult men and whether this is protected by allopurinol. METHODS: A randomized, controlled trial of 74 adult men who were administered 200 g fructose daily for 2 weeks with or without allopurinol. Primary measures included changes in ambulatory blood pressure (BP), fasting lipids, glucose and insulin, homeostatic model assessment (HOMA) index, body mass index and criteria for metabolic syndrome. RESULTS: The ingestion of fructose resulted in an increase in ambulatory BP (7+/-2 and 5+/-2 mm Hg for systolic (SBP) and diastolic BP (DBP), P<0.004 and P<0.007, respectively). Mean fasting triglycerides increased by 0.62+/-0.23 mmol l(-1) (55+/-20 mg per 100 ml), whereas high-density lipoprotein cholesterol decreased by 0.06+/-0.02 mmol l(-1) (2.5+/-0.7 mg per 100 ml), P<0.002 and P<0.001, respectively. Fasting insulin and HOMA indices increased significantly, whereas plasma glucose level did not change. All liver function tests showed an increase in values. The metabolic syndrome increased by 25-33% depending on the criteria. Allopurinol lowered the serum uric acid level (P<0.0001) and prevented the increase in 24-h ambulatory DBP and daytime SBP and DBP. Allopurinol treatment did not reduce HOMA or fasting plasma triglyceride levels, but lowered low-density lipoprotein cholesterol relative to control (P<0.02) and also prevented the increase in newly diagnosed metabolic syndrome (0-2%, P=0.009). CONCLUSIONS: High doses of fructose raise the BP and cause the features of metabolic syndrome. Lowering the uric acid level prevents the increase in mean arterial blood pressure. Excessive intake of fructose may have a role in the current epidemics of obesity and diabetes.

[Evidence-based ophthalmology: critical evaluation of the literature in relation to diagnostic tests]. / Oftalmología basada en pruebas: evaluación crítica de la literatura sobre pruebas diagnósticas.

PURPOSE: In general, articles on diagnostic tests have a very poor methodological quality. If we translate their conclusions to daily practice without a proper analysis it is easy to see a typical trend: physicians use new (and expensive) tests without increasing diagnostic capacity; they only increase the health budget. Evidence-based medicine (EBM) consists of using the best evidence in decision-making. It deals with selected and relevant information, supported by data obtained through the most rigorous scientific method: epidemiology and statistics. Critical evaluation of papers related to diagnostic tests is our aim. We provide with basic skills for evaluation and analysis of papers by means of simple topics on statistics, design of clinical assays and clinical epidemiology. METHODS: Review of the medical literature. RESULTS: To evaluate papers on diagnostic tests and to use a test correctly, it is necessary to know its diagnostic capacity, the level of certainty to start treatment, the probability of having the disease before using the test and the test capacity to change that probability. CONCLUSIONS: The maximum performance of a test is reached when it is used in a maximum uncertainty situation (disease probability 50%). Its highest usefulness is obtained when pre-test probability is maximal, after a careful review of the patient's history and a complete patient examination.

Removal of emerging organic contaminants in a poplar vegetation filter.

Vegetation filters (VFs), a type of land application system, are a robust technology based on natural treatment mechanisms for the removal of wastewater contaminants. Their capacity to attenuate emerging organic contaminants (EOCs) has not yet been evaluated. The present study reports the results of a 2-year EOC monitoring carried out using a poplar VF receiving wastewater primarily treated by an Imhoff tank. The compounds selected included analgesics, a ß-adrenergic blocker, stimulants, an anticonvulsant, an anti-depressant, an anti-inflammatory, an antibiotic and analgesic and stimulant metabolites. EOCs were analysed in the Imhoff tank effluent, in the infiltrated water at a depth of 90cm and in the groundwater at a depth of 10m. The results demonstrated that EOC attenuation was more significant in the first 90cm than in the rest of the soil profile. The removal efficiency for all of the selected EOCs was higher than 90% with the exception of ketoprofen, which may pose a higher threat of groundwater contamination. The observed attenuation correlated with the hydrophobicity and charge state of the EOCs. The higher persistence of the metabolites 4-AAA and 4-FAA shows that progression in the degradation pathway does not always imply a mitigation of contamination.

Population-Based National Prevalence of Thyroid Dysfunction in Spain and Associated Factors: Di@bet.es Study.

BACKGROUND: The aim of this study was to investigate the national prevalence of thyroid dysfunction in Spain and its association with various clinical, environmental, and demographic variables. METHODS: The study included 4554 subjects (42.4% men) with a mean age of 50 years (range 18-93 years), who were participants in a national, cross-sectional, population-based survey conducted in 2009-2010. Data gathered included clinical and demographic characteristics, physical examination, and blood sampling. Thyrotropin, free thyroxine, free triiodothyronine, and thyroid peroxidase antibody (TPOAb) concentrations were analyzed by electrochemiluminescence. Urinary iodine (UI) levels were measured in an isolated urine sample. RESULTS: The prevalence of treated hypothyroidism, untreated subclinical hypothyroidism, and untreated clinical hypothyroidism was 4.2% [confidence interval (CI) 3.6-4.9%], 4.6% [CI 4.0-5.2%], and 0.3% [CI 0.1-0.5%], respectively. The prevalence of total hypothyroidism (including all fractions) was 9.1% [CI 8.2-10.0%]. The prevalence of total hyperthyroidism was 0.8% [CI 0.6-1.1]. A total of 7.5% [CI 6.7-8.3%] of the population tested positive for TPOAbs (≥50 IU/mL). In multivariate logistic regression models, TPOAbs were strongly associated with both hypothyroidism (p < 0.001) and hyperthyroidism (p = 0.005), whereas high UI levels (>200 µg/g creatinine) were associated with hypothyroidism (p < 0.001). The positive association between UI and hypothyroidism remained for both treated (p < 0.001) and untreated (p < 0.05) hypothyroidism, whereas it was especially significant for non-autoimmune (TPOAbs negative) forms (p < 0.001). At UI levels ≥200 µg/g, there was a positive correlation between UI and thyrotropin levels (ß = 0.152, p < 0.001) and a negative correlation between UI and free triiodothyronine levels (ß = -0.134, p = 0.001). CONCLUSION: According to the data, a large proportion (10%) of the Spanish population has some evidence of thyroid dysfunction. High TPOAb concentrations were associated with both hypo- and hyperthyroidism, whereas high UI concentrations were associated with hypothyroidism.

The Almadén district (Spain): anatomy of one of the world's largest Hg-contaminated sites.

We present data from an early reconnaissance survey (stream sediments, soil, and water Hg chemistry; plants and water crustaceans Hg intake) of the Almadén district (central Spain), that was carried out to establish the potential environmental hazards derived from the anomalous mercury concentrations measured in this realm. The Almadén mercury district (approximately 300 km2) can be regarded as the largest geochemical anomaly of mercury on Earth. The district includes a series of mercury mineral deposits, having in common a simple mineralogy (dominant cinnabar: HgS, and minor pyrite: FeS2). The ore deposits have been mined for more than 2000 years, and the main mine of the district (Almadén), has been active from Roman times to present day with almost no interruptions. The mercury distribution in soils of the district reveals the existence of high, and extremely high mercury values (up to 8889 microg g(-1)), whereas concentrations in stream sediments and waters reach exceptional values of up to 16,000 microg g(-1) and 11,200 ng l(-1) respectively. On the other hand, very high concentrations of methylmercury (MeHg) have been detected in calcines (up to 3100 ng g(-1)), sediments (0.32-82 ng g(-1)), and waters (0.040-30 ng l(-1)). Mercury gets incorporated to edible river crustaceans and plants. The red swamp crayfish Procambarus clarkii, has Hg concentrations of up to 9060 ng g(-1) (muscle) and 26,150 ng g(-1) (hepatopancreas). Regarding plants, the local wild asparagus (Asparagus acutifolius) yields values of up to 298 microg g(-1) Hg. Mercury also escapes to the atmosphere, and mineral deposits, together with metallurgical activities, generate strong anomalies of atmospheric Hg. The most important concentrations relate to the emissions from the Almadén metallurgical roaster, in the order of 14,000 ng Hg m(-3). Additionally, large open pit operations also contribute to the district atmospheric pool of mercury, with high concentrations above 1000 ng Hg m(-3). Thus, no system (rocks, soils, sediments, waters, atmosphere, biota) in the Almadén district is free from strong Hg contamination.

Intraoperative complications of planned extracapsular cataract extraction versus manual nucleofragmentation.

PURPOSE: To compare the intraoperative complications of planned extracapsular cataract extraction (ECCE) with those of manual nucleofragmentation. SETTING: Hospital de la Esperanza, Universitat Autónoma de Barcelona, Spain. METHODS: This retrospective study comprised 567 eyes; 444 had planned ECCE and 123, manual nucleofragmentation through a scleral tunnel incision. RESULTS: No significant differences between techniques were found in terms of intraoperative complications (P < .05). Manual nucleofragmentation did not increase the risk of intraoperative complications (P < .05). CONCLUSIONS: Although phacoemulsification is the procedure of choice in many cases, manual nucleofragmentation is a safe and valid alternative that achieves the goals of small incision cataract surgery.

Endoscope-assisted transscleral suture fixation of intraocular lenses.

We describe a new method for placing transscleral sutures when fixating posterior chamber intraocular lenses to the sulcus. An intraocular microendoscope with an 18 gauge probe is used for direct sulcus observation and needle position assessment. The straight needle of a 10-0 polypropylene suture and the tip of the probe are placed in a 16 gauge silicone rubber tube to hold them together. Fixing the needle to the endoscope allows a direct view of its tip and requires only one hand. The other hand is used to grasp the tip of the needle when it comes out under the scleral flap after passing through the sulcus. Assessment of needle position with an endoscope avoids surgically induced iris root or ciliary body damage. Fixing the needle to the endoscope simplifies the surgical technique.

Manual nucleofragmentation and endothelial cell loss.

PURPOSE: To compare corneal endothelial cell loss with two cataract surgery techniques: manual nucleofragmentation performed with the Keener nucleus divider and planned extracapsular extraction. SETTING: Department of Ophthalmology "Memorial Cristóbal Garrigosa," Hospital de l'Esperança, Universitat Autònoma de Barcelona, Spain. METHODS: Contact specular microscopy was performed before and 8 weeks after surgery in 51 patients who had been prospectively randomized into 2 groups: 26 patients had manual nucleofragmentation (NF) with the Keener divider and 25, planned extracapsular cataract extraction (ECCE). The analyzed parameters were preoperative and postoperative endothelial cell density and variations in cell size (polymegethism) and cell shape (pleomorphism). The results were compared and statistically analyzed. RESULTS: The mean percentage of endothelial cell loss in the NF group was 11.08% and in the ECCE group, 9.86%. This difference was not statistically significant. Postoperative variation in cell shape and size did not differ significantly between the two groups and was fairly constant. CONCLUSION: The percentage of endothelial cell loss that occurred with manual NF using the Keener nucleus divider was similar to the one that occurs with other cataract surgery techniques. The small variation detected in postoperative endothelial morphology suggests that this endothelial cell population is stable.

[Ocular toxoplasmosis in patients with acquired immunodeficiency syndrome]. / Toxoplasmosis ocular en pacientes con síndrome de inmunodeficiencia adquirida.

Ocular toxoplasmosis is an uncommonly reported complication in patients with acquired immunodeficiency syndrome. Three patients with human immunodeficiency virus (HIV) infection and ocular toxoplasmosis are reported. In two of them, cerebral toxoplasmosis was associated. Ocular involvement presented as exudative chorioretinitis, bilateral in 2 cases and unilateral in 1. The diagnosis was made on the basis of ocular disease associated with lesions consistent with toxoplasmosis of central nervous system (CNS) and response to antitoxoplasma treatment in one case, and ocular disease with rising antitoxoplasma serologic titers in the remaining two. Initial therapy included pyrimethamine plus sulfadiazine in 2 cases and pyrimethamine plus clindamycin in 1. The 2 patients treated with sulfadiazine showed hypersensitivity features, and clindamycin had to be substituted. The response to therapy was favorable, although one patient died few days after the development of CNS lesions. When chorioretinitis develops in a patient with HIV infection, ocular toxoplasmosis should be considered. As CNS involvement is commonly associated and relapse after the withdrawal of therapy is likely, these patients should be treated as those with isolated toxoplasma encephalitis.

Towards a model to predict macular dichromats' naming errors: effects of CIE saturation and dichromatism type.

Thirty macular dichromat children (12 protanopes + 18 deuteranopes) and 29 controls, between 5 and 9 years old, participated in a monolexemic denomination task. Their clinical status was determined after a repeated application of a chromatic test set (Ishihara, CUCVT, and TIDA). The stimuli to be named were 12 tiles from the Color-Aid set belonging to the green, blue, and purple basic categories. Results showed that: (a) Dichromats made more naming errors when low saturation stimuli were used; (b) protanopes made more errors that deuteranopes; and (c) pseudoisochromatic lines predicted accurately the type of most frequent naming errors but they underestimated macular dichromats' functional capacity to name colors. Results are consistent with a model of macular dichromats' vision that hypothesizes a residual third type of cone in the periphery of the retina. Implications of this fact for everyday use of colors by macular dichromats' and for the validity of standard clinical diagnoses are discussed.

Effects of seed burial on germination, protein mobilisation and seedling survival in Dodonaea viscosa.

Ecological restoration of disturbed areas requires substantial knowledge of the germination of native plants and the creation of novel methods to increase seedling establishment in the field. We studied the effects of soil matrix priming on the germination of Dodonaea viscosa seeds, which exhibit physical dormancy. To this end, we buried both pre-scarified (in H2SO4, 3 min) and non-pre-scarified seeds in the Parque Ecológico de la Ciudad de México. After seeds were unearthed, they were post-scarified for 0, 2, 6 and 10 min and their germination percentages compared to the germination of a control batch of laboratory-stored seeds. For both control and unearthed seeds, the protein pattern was determined in the enriched storage protein fraction in SDS-PAGE gels stained with Coomassie blue. Percentage germination increased as the scarification time increased. Pre-scarification significantly increased percentage germination of post-scarified seeds in relation to the control and non-pre-scarified seeds. In seeds unearthed from the forest site, the buried pre-scarified seeds had relatively high percentage germination, even in the absence of post-scarification treatment. A 48-kDa protein was not found in unearthed, pre-scarified seeds nor in the control germinated seeds, indicating that mobilisation of this protein occurred during soil priming. Burying seeds for a short period, including the beginning of the rainy season, promoted natural priming, which increased protein mobilisation. Functionally, priming effects were reflected in high percentage seedling survival in both the shade house and the field. Seed burial also reduced the requirement for acidic post-scarification.

Reciprocal sympatho-sensory control: functional role of nucleotides and calcitonin gene-related peptide in a peripheral neuroeffector junction.

The rat vas deferens has scattered sensory afferens plus a dense network of sympathetic motor efferens; these fibers are not known to interact functionally. We ascertained whether sensory fibers modulate the release of sympathetic transmitters through the release of calcitonin gene-related peptide (CGRP) and reciprocally assessed whether sympathetic transmitters modulate the overflow of ir-CGRP from sensory fibers. The tissue overflow of electrically evoked sympathetic co-transmitters (ATP/metabolites, noradrenaline (NA), and immunoreactive neuropeptide tyrosine (ir-NPY)) and the motor responses elicited were quantified following either exogenous CGRP or capsaicin application to elicit peptide release. Conversely, the outflow of ir-CGRP was examined in the presence of sympathetic transmitters. Exogenous CGRP reduced in a concentration-dependent manner the electrically evoked outflow of ATP/metabolites, NA, and ir-NPY with EC(50) values of 1.3, 0.18, and 1.9 nM, respectively. CGRP also reduced the basal NA overflow. The CGRP-evoked modulation was blocked by CGRP8-37 or H-89. Release of endogenous CGRP by capsaicin significantly reduced the basal overflow of NA, ir-NPY, and the electrically evoked sympathetic transmitter release. ADP, 2-methylthioadenosine-5'-O-diphosphate (2-MeSADP), or UTP decreased the electrically evoked ir-CGRP overflow, whereas clonidine, α,ß-methyleneadenosine 5'-triphosphate (α,ß-mATP), or adenosine (ADO) were inactive. CGRP acting postjunctionally also reduced the motor responses elicited by exogenous NA, ATP, or electrically evoked contractions. We conclude that CGRP exerts a presynaptic modulator role on sympathetic nerve endings and reciprocally ATP or related nucleotides influence the release of ir-CGRP from sensory fibers, highlighting a dynamic sympatho-sensory control between sensory fibers and sympathetic nerve ending. Postjunctional CGRP receptors further contribute to reduce the tissue sympathetic motor tone implying a pre and postjunctional role of CGRP as a sympathetic tone modulator.

Analytical performance of a sensitive assay for cardiac troponin I with loci technology.

OBJECTIVES: To confirm the analytical performance of the Dimension Vista LOCI troponin I assay (cTnI). DESIGN AND METHOD: Limit of blank (LoB), limit of detection (LoD), limit of quantitation (LoQ) with a 10% coefficient of variation (CV), linearity, precision, method comparison, and 99th percentile upper reference limits (URL) were analyzed. Endogenous analytes and rheumatoid factor (RF) were tested for assay interference. RESULTS: The 99th percentile was 0.022 microg/L (CV=14%) and the LoQ was 0.036 microg/L. The ratio of 10% CV concentration to 99th percentile was 1.63. Linearity extended from 0 to 44.36 microg/L. The method comparison equation was Dimension(R) Vista=0.94 (Dimension RxL)+0.00 microg/L with bias at low levels. No interference was detected. CONCLUSIONS: This study shows acceptable performance characteristics of the LOCI cTnI assay on Dimension Vista to diagnosis and risk stratification of patients with acute coronary syndrome symptoms.

A single-institution experience with treatment of severe acute chest syndrome: lack of rebound pain with dexamethasone plus transfusion therapy.

The use of corticosteroid therapy for the treatment of acute chest syndrome (ACS) in patients with sickle cell disease has been infrequently used owing to concerns for rebound pain. Here, we report a cohort of patients<21 years of age with sickle cell disease treated between January 2001 and June 2006 for severe ACS with both corticosteroids and transfusion therapy. We reviewed 53 episodes of severe ACS with an average hospital duration of 4.9 days. Only 1 patient out of 6 who were transferred to the intensive care unit required intubation. None of the ACS episodes resulted in death and none of the 4 readmissions after discharge were due to pain. There was no acute toxicity related to either corticosteroid or transfusion therapy.

The As-contaminated Elqui river basin: a long lasting perspective (1975-1995) covering the initiation and development of Au-Cu-As mining in the high Andes of northern Chile.

The Elqui watershed (northern Chile) constitutes a highly contaminated river system, with arsenic exceeding by up to three orders of magnitude the average for river waters. There are three main reasons that explain this contamination: (1) the regional geology and hydrothermal (mineralizing) processes that developed in this realm during Miocene time; (2) the later unroofing-erosion-oxidation-leaching of As-Cu rich sulfide ores, a process that have been taking place for at least 10,000 years; and last but not least (3) mining activities at the high-altitude (>4000 m above sea level) Au-Cu-As El Indio mine, from the late 1970s onwards. The El Indio mineral deposit hosted large veins of massive sulfides, including the important presence of enargite (Cu(3)AsS(4)). The continuous natural erosion of these veins and their host rocks (also rich in As and Cu) during Holocene time, led to important and widespread metal dispersion along the river system. During the studied pre mining period (1975-1977), the high altitude river Toro waters already showed very large As concentrations (0.36-0.52 mg l(-1)). The initiation of full scale mining at El Indio (1980 onwards) led to an increase of these values, reaching a concentration of 1.51 mg l(-1) As in 1995. During the same year other rivers of the watershed reached peak As concentrations of 0.33 (Turbio) and 0.11 mg l(-1) (Elqui). These figures largely exceed the USEPA regulations for drinking water (0.01 mg l(-1) As), and about 10% of the total As data from the river Elqui (and 70% from the river Turbio) are above the maximum level allowed by the Chilean law for irrigation water (0.1 mg l(-1) As).